Healthcare Provider Details

I. General information

NPI: 1467388322
Provider Name (Legal Business Name): TOLEDO CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CARUSO AVE
GLENDALE CA
91210-1520
US

IV. Provider business mailing address

4235 SECOR RD
TOLEDO OH
43623-4299
US

V. Phone/Fax

Practice location:
  • Phone: 419-214-4214
  • Fax:
Mailing address:
  • Phone: 419-214-4214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMBER D PENIX
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 419-214-4214