Provider Demographics
NPI:1861041949
Name:TOFFOLLA, SHARON RENEE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:RENEE
Last Name:TOFFOLLA
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 1:275 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-1316
Mailing Address - Country:US
Mailing Address - Phone:909-553-6367
Mailing Address - Fax:
Practice Address - Street 1:275 E 41ST ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-1316
Practice Address - Country:US
Practice Address - Phone:909-553-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider