Provider Demographics
NPI:1659870673
Name:TOLEDO, SOFIA ELISSE
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:ELISSE
Last Name:TOLEDO
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 1:17529 151ST AVE SE UNIT 7-1
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-8793
Mailing Address - Country:US
Mailing Address - Phone:818-450-4742
Mailing Address - Fax:
Practice Address - Street 1:5436 232ND AVE SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6220
Practice Address - Country:US
Practice Address - Phone:206-380-3009
Practice Address - Fax:206-380-3009
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician