=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477590792
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUIS R. ROSA TOLEDO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 08/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | B43 CALLE ELLIOT VELEZ URB. ATENAS
-----------------------------------------------------
City | MANATI
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00674-4615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-854-4122
-----------------------------------------------------
Fax | 787-854-3270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 4 BOX 30335
-----------------------------------------------------
City | HATILLO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00659-9408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-854-4122
-----------------------------------------------------
Fax | 787-854-3270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 11488
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------