Provider Demographics
NPI:1447454137
Name:RODRIGUEZ-TOLEDO, JOHANNA (MD)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:RODRIGUEZ-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 1:26800 CROWN VALLEY PKWY STE 510
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8028
Mailing Address - Country:US
Mailing Address - Phone:949-364-8700
Mailing Address - Fax:
Practice Address - Street 1:26800 CROWN VALLEY PKWY STE 510
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8028
Practice Address - Country:US
Practice Address - Phone:949-364-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109148208000000X
PR16678202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner