Healthcare Provider Details

I. General information

NPI: 1275841058
Provider Name (Legal Business Name): JOSE G TOCA CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SW 172ND AVE
MIRAMAR FL
33029-5592
US

IV. Provider business mailing address

7700 W SUNRISE BLVD
PLANTATION FL
33322-4113
US

V. Phone/Fax

Practice location:
  • Phone: 954-538-5171
  • Fax:
Mailing address:
  • Phone: 720-462-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA64
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: