Provider Demographics
NPI:1497283147
Name:DUBOSE, TOINETTE LEIGH
Entity Type:Individual
Prefix:
First Name:TOINETTE
Middle Name:LEIGH
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19309 SMITH GIN ST
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-3983
Mailing Address - Country:US
Mailing Address - Phone:512-659-1360
Mailing Address - Fax:512-551-8210
Practice Address - Street 1:19309 SMITH GIN ST
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-3983
Practice Address - Country:US
Practice Address - Phone:512-659-1360
Practice Address - Fax:512-551-8210
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA0600X, 251E00000X
320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities