Provider Demographics
NPI:1336498997
Name:TOLEDO, DIANA R (EDS)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:R
Last Name:TOLEDO
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:SANDOVAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7204 COULSON DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-280-0226
Mailing Address - Fax:
Practice Address - Street 1:19676 NEW MEXICO 314
Practice Address - Street 2:
Practice Address - City:BELEN NM
Practice Address - State:NM
Practice Address - Zip Code:87002
Practice Address - Country:US
Practice Address - Phone:505-966-1870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM350748103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool