Healthcare Provider Details

I. General information

NPI: 1295377554
Provider Name (Legal Business Name): JUAN TOLEDO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR # 8765
SAN DIEGO CA
92103-1911
US

IV. Provider business mailing address

909 AGATE ST UNIT 2
SAN DIEGO CA
92109-1189
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-3520
  • Fax: 619-543-5829
Mailing address:
  • Phone: 858-952-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: