Provider Demographics
NPI:1104812791
Name:TOLEDO, MINDA LAO (MD)
Entity type:Individual
Prefix:DR
First Name:MINDA
Middle Name:LAO
Last Name:TOLEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 9TH AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642
Mailing Address - Country:US
Mailing Address - Phone:409-729-9200
Mailing Address - Fax:409-729-9235
Practice Address - Street 1:8333 9TH AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642
Practice Address - Country:US
Practice Address - Phone:409-729-9200
Practice Address - Fax:409-729-9235
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2487208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM2487OtherLIC NO.
TX1417006735OtherGROUP NPI
TX20-3418877OtherTAX ID
TX178296301Medicaid
TX178296302Medicaid
TX178297101Medicaid
TX178297101Medicaid
TX1417006735OtherGROUP NPI