Basic Information
| Provider Information | |||||||||
| NPI: | 1679771307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOSEPH | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | MARLENE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 CHRISTINA AVE | ||||||||
| Address2: | |||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930128101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053891019 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4333 E VINEYARD AVE | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930361013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059815576 | ||||||||
| FaxNumber: | 8059815674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT24842 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.