Healthcare Provider Details

I. General information

NPI: 1447454137
Provider Name (Legal Business Name): JOHANNA RODRIGUEZ-TOLEDO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY STE 510
MISSION VIEJO CA
92691-8028
US

IV. Provider business mailing address

26800 CROWN VALLEY PKWY STE 510
MISSION VIEJO CA
92691-8028
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-8700
  • Fax:
Mailing address:
  • Phone: 949-364-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA109148
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number16678
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: