Provider Demographics
NPI:1427126648
Name:TOLEDO-NADER, CAROLL (MD)
Entity type:Individual
Prefix:
First Name:CAROLL
Middle Name:
Last Name:TOLEDO-NADER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CAROLL
Other - Middle Name:
Other - Last Name:TOLEDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:345 F STREET STE 110
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910
Mailing Address - Country:US
Mailing Address - Phone:619-422-1154
Mailing Address - Fax:619-422-6491
Practice Address - Street 1:345 F STREET STE 110
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-422-1154
Practice Address - Fax:619-422-6491
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA414860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A414860Medicaid
CA00A414860Medicaid
E89027Medicare UPIN