Provider Demographics
NPI:1114192713
Name:TOLOSA-GLORIA, CAROLINE A (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:A
Last Name:TOLOSA-GLORIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 N ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1163
Mailing Address - Country:US
Mailing Address - Phone:719-542-7222
Mailing Address - Fax:
Practice Address - Street 1:3116 N ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1163
Practice Address - Country:US
Practice Address - Phone:719-542-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99729016Medicaid
COH67204Medicare UPIN
CO472028Medicare PIN