Provider Demographics
NPI:1619642014
Name:BLUFFTON, TOYOKTA WEWOKA
Entity Type:Individual
Prefix:
First Name:TOYOKTA
Middle Name:WEWOKA
Last Name:BLUFFTON
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 1:1309 SAMPLE ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-2831
Mailing Address - Country:US
Mailing Address - Phone:318-461-2535
Mailing Address - Fax:
Practice Address - Street 1:1309 SAMPLE ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-2831
Practice Address - Country:US
Practice Address - Phone:318-461-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA621AGK343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)