Healthcare Provider Details

I. General information

NPI: 1861626608
Provider Name (Legal Business Name): TOSHA A LARIOS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TOSHA A GEORGE DPM

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3198 N WINDSONG DR
PRESCOTT VALLEY AZ
86314-2239
US

IV. Provider business mailing address

965 SUTTER ST APT 307
SAN FRANCISCO CA
94109-6068
US

V. Phone/Fax

Practice location:
  • Phone: 928-925-7194
  • Fax:
Mailing address:
  • Phone: 928-925-7194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number322
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberAZ0684
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: