Healthcare Provider Details

I. General information

NPI: 1386328540
Provider Name (Legal Business Name): ZOMY TOLEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3271 NW 7TH ST STE 203
MIAMI FL
33125-4141
US

IV. Provider business mailing address

2482 W 4TH CT
HIALEAH FL
33010-1430
US

V. Phone/Fax

Practice location:
  • Phone: 786-220-6902
  • Fax:
Mailing address:
  • Phone: 786-899-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH23891
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: