Provider Demographics
NPI:1447905534
Name:TOLETE, ROXANNE OVALLES
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:OVALLES
Last Name:TOLETE
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 1:2340 E 8TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2875
Mailing Address - Country:US
Mailing Address - Phone:619-470-7007
Mailing Address - Fax:
Practice Address - Street 1:2340 E 8TH ST STE D
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2875
Practice Address - Country:US
Practice Address - Phone:619-470-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95016173363LF0000X
CANPF95016173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily