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NPI Code Detail

MEDICARE: IVA TOLJ

MEDICARE: IVA TOLJ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramTX

General Provider Information

NPI Number : 1558200857
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVA TOLJ
Provider Business Mailing Address
First Line : 2820 W MICHAELANGELO DR
Second Line :
City : EDINBURG
State : TX
Zip : 78539-1402
Country : US
Telephone Number : 956-558-6400
Fax Number :
Provider Business Practice Location Address
First Line : 2820 W MICHAELANGELO DR
Second Line :
City : EDINBURG
State : TX
Zip : 78539-1402
Country : US
Telephone Number : 956-558-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2026
Last Update Date : 03/25/2026

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Directions to “ IVA TOLJ ” Practice Location

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