Provider Demographics
NPI:1396422317
Name:TOALSON, DEOLA OLIVE
Entity type:Individual
Prefix:
First Name:DEOLA
Middle Name:OLIVE
Last Name:TOALSON
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 1:9225 LAS CAMAS RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2431
Mailing Address - Country:US
Mailing Address - Phone:505-359-0091
Mailing Address - Fax:
Practice Address - Street 1:9225 LAS CAMAS RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2431
Practice Address - Country:US
Practice Address - Phone:505-359-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician