Healthcare Provider Details

I. General information

NPI: 1902574197
Provider Name (Legal Business Name): RONALD TOLEDO CARDOSO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 W 78TH ST STE 230
EDINA MN
55439-2570
US

IV. Provider business mailing address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

V. Phone/Fax

Practice location:
  • Phone: 952-946-9777
  • Fax:
Mailing address:
  • Phone: 612-873-3000
  • Fax: 612-873-1928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14688
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: