Healthcare Provider Details

I. General information

NPI: 1427462027
Provider Name (Legal Business Name): MARIA A TOLOZA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3094 CRESCENT ST APT 6C
ASTORIA NY
11102-2762
US

IV. Provider business mailing address

3094 CRESCENT ST APT 6C
ASTORIA NY
11102-2762
US

V. Phone/Fax

Practice location:
  • Phone: 917-818-2170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number566066-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401972
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: