Provider Demographics
NPI:1861697013
Name:TOLOSA, RENATO L (IDC)
Entity type:Individual
Prefix:
First Name:RENATO
Middle Name:L
Last Name:TOLOSA
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-8720
Mailing Address - Country:US
Mailing Address - Phone:951-765-9978
Mailing Address - Fax:
Practice Address - Street 1:1285 LAVENDER LN
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-8720
Practice Address - Country:US
Practice Address - Phone:951-765-9978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman