Healthcare Provider Details

I. General information

NPI: 1386868164
Provider Name (Legal Business Name): TOLEDO PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 4 BOX 49500
HATILLO PR
00659-9481
US

IV. Provider business mailing address

PO BOX 351
ARECIBO PR
00613-0351
US

V. Phone/Fax

Practice location:
  • Phone: 787-607-6012
  • Fax: 787-422-2238
Mailing address:
  • Phone: 787-607-6012
  • Fax: 787-422-2238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number645
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number645
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS TOLEDO
Title or Position: PRESIDENT
Credential: O.D.
Phone: 787-309-6323