Healthcare Provider Details

I. General information

NPI: 1477605970
Provider Name (Legal Business Name): JOSE JAVIER TOLOSA D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9410 LOS ROMERO AVE. SUITE 207
SAN JUAN PR
00926
US

IV. Provider business mailing address

B7 CALLE SANTA ISABEL
SAN JUAN PR
00926-5417
US

V. Phone/Fax

Practice location:
  • Phone: 787-790-2420
  • Fax: 787-790-2455
Mailing address:
  • Phone: 787-764-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2755
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: