Provider Demographics
NPI:1689297913
Name:TOLEDANO, SHIR (RD)
Entity Type:Individual
Prefix:
First Name:SHIR
Middle Name:
Last Name:TOLEDANO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 LARCH LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5042
Mailing Address - Country:US
Mailing Address - Phone:916-798-1040
Mailing Address - Fax:
Practice Address - Street 1:860 LARCH LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5042
Practice Address - Country:US
Practice Address - Phone:916-798-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86108334133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered