Provider Demographics
NPI:1285143412
Name:TOLOSSA, DAVID ENRIQUE II (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ENRIQUE
Last Name:TOLOSSA
Suffix:II
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 E GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-8056
Mailing Address - Country:US
Mailing Address - Phone:909-387-7194
Mailing Address - Fax:909-387-7100
Practice Address - Street 1:780 E GILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-8056
Practice Address - Country:US
Practice Address - Phone:909-387-7194
Practice Address - Fax:909-387-7100
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 102L00000X, 171M00000X, 225400000X
CA103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No171M00000XOther Service ProvidersCase Manager/Care Coordinator