Basic Information
| Provider Information | |||||||||
| NPI: | 1285143412 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOLOSSA | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ENRIQUE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 780 E GILBERT ST | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924158056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093877194 | ||||||||
| FaxNumber: | 9093877100 | ||||||||
| Practice Location | |||||||||
| Address1: | 780 E GILBERT ST | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924158056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093877194 | ||||||||
| FaxNumber: | 9093877100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2017 | ||||||||
| LastUpdateDate: | 09/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | CA | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.