Provider Demographics
NPI:1477590792
Name:ROSA TOLEDO, LUIS R (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:R
Last Name:ROSA TOLEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 30335
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9408
Mailing Address - Country:US
Mailing Address - Phone:787-854-4122
Mailing Address - Fax:787-854-3270
Practice Address - Street 1:B43 CALLE ELLIOT VELEZ
Practice Address - Street 2:URB. ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4615
Practice Address - Country:US
Practice Address - Phone:787-854-4122
Practice Address - Fax:787-854-3270
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1297OtherPMC MEDICARE CHOICE
PRN221OtherINTERNATIONAL MEDICAL CAR
PRPE2903OtherPALIC
PR065970OtherCRUZ AZUL
PR3603105OtherACCA
PR8-4426OtherSSS
PR995224OtherMMM
PR2-11488OtherCIGNA
PR6740012OtherHUMANA HEALTH PLANS
PR990183OtherHEALTH PLUS
PR8-4426Medicare ID - Type Unspecified
PR065970OtherCRUZ AZUL