Healthcare Provider Details

I. General information

NPI: 1306151212
Provider Name (Legal Business Name): GILBERTO E TOSTADO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. 6 #255
AGUA PRIETA SONORA
84200
MX

IV. Provider business mailing address

PO BOX 1052
DOUGLAS AZ
85608-1052
US

V. Phone/Fax

Practice location:
  • Phone: 520-805-0894
  • Fax:
Mailing address:
  • Phone: 520-805-0894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number653995
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: