Provider Demographics
NPI:1972721330
Name:TOLEDO, ERNESTO LUIS (M D)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:LUIS
Last Name:TOLEDO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN GERMAN MEDICAL PLAZA SUITE 203 205
Mailing Address - Street 2:CARR 2 KM 174
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0000
Mailing Address - Country:US
Mailing Address - Phone:787-778-4516
Mailing Address - Fax:787-798-0880
Practice Address - Street 1:712 53RD AVE E STE B
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-5827
Practice Address - Country:US
Practice Address - Phone:941-755-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7005207P00000X, 208D00000X
FLACN779208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC-79716Medicare UPIN
PR28109Medicare ID - Type Unspecified