Healthcare Provider Details

I. General information

NPI: 1639565963
Provider Name (Legal Business Name): JOSSETTE AXTMAYER-TOLOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 12/21/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 47.7
MANATI PR
00674
US

IV. Provider business mailing address

CARR 2 KM 47.7
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3322
  • Fax:
Mailing address:
  • Phone: 787-621-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19955
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number19955
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: