Provider Demographics
NPI:1144230343
Name:TOLEDO-COURET, MARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:TOLEDO-COURET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 W PIERCE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3518
Mailing Address - Country:US
Mailing Address - Phone:575-628-8852
Mailing Address - Fax:575-628-8856
Practice Address - Street 1:2420 W PIERCE ST STE 105
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3518
Practice Address - Country:US
Practice Address - Phone:575-628-8852
Practice Address - Fax:575-628-8856
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0088207V00000X
MI4301062524207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM15537773Medicaid
MI4970432Medicaid
MI2968382Medicaid
MIE20573Medicare UPIN
NM15537773Medicaid
MI0M38450Medicare PIN