MEDICARE: ELIZABETH YVETTE TOLBERT

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
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1588804389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH YVETTE TOLBERT

Provider Business Mailing Address
First Line	:	4700 STRINGFELLOW ST APT 501
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-1975
Country	:	US
Telephone Number	:	210-792-4029
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 STRINGFELLOW ST APT 501
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-1975
Country	:	US
Telephone Number	:	210-792-4029
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	03/06/2009

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