Provider Demographics
NPI:1114984887
Name:TOZBIKIAN, CARMELITA MIRABUENO (MD)
Entity Type:Individual
Prefix:
First Name:CARMELITA
Middle Name:MIRABUENO
Last Name:TOZBIKIAN
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 1:1 VALLEY ST
Mailing Address - Street 2:ONE CHILDREN'S MEDICAL PLAZA
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1779
Mailing Address - Country:US
Mailing Address - Phone:937-641-5848
Mailing Address - Fax:
Practice Address - Street 1:1 VALLEY ST
Practice Address - Street 2:ONE CHILDREN'S MEDICAL PLAZA
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1779
Practice Address - Country:US
Practice Address - Phone:937-641-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.042373207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000541696OtherANTHEM
OH0367204Medicaid
OH000000541696OtherANTHEM