Healthcare Provider Details

I. General information

NPI: 1780159566
Provider Name (Legal Business Name): MARY JOAN APODACA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 N ERIE ST
TOLEDO OH
43604-5317
US

IV. Provider business mailing address

635 N ERIE ST
TOLEDO OH
43604-5317
US

V. Phone/Fax

Practice location:
  • Phone: 419-213-4121
  • Fax: 419-213-4196
Mailing address:
  • Phone: 419-213-4121
  • Fax: 419-213-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number258694
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: