Healthcare Provider Details

I. General information

NPI: 1346028339
Provider Name (Legal Business Name): JUANITA TOLEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 E MANNING AVE
REEDLEY CA
93654-9467
US

IV. Provider business mailing address

5442 W WATHEN AVE
FRESNO CA
93722-3641
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax:
Mailing address:
  • Phone: 559-801-4881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: