Provider Demographics
NPI:1679923965
Name:LUGO TOLEDO, JOSE A (RN)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:LUGO TOLEDO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2211
Mailing Address - Country:US
Mailing Address - Phone:305-823-3312
Mailing Address - Fax:305-884-3989
Practice Address - Street 1:3611 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4307
Practice Address - Country:US
Practice Address - Phone:305-823-3312
Practice Address - Fax:305-884-3989
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9429037163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology