Healthcare Provider Details

I. General information

NPI: 1336498997
Provider Name (Legal Business Name): DIANA R TOLEDO ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANA SANDOVAL

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19676 NEW MEXICO 314
BELEN NM NM
87002
US

IV. Provider business mailing address

7204 COULSON DR NE
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-966-1870
  • Fax:
Mailing address:
  • Phone: 505-280-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number350748
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: