Healthcare Provider Details

I. General information

NPI: 1942117353
Provider Name (Legal Business Name): JOSH JORGENSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10153 E HAMPTON AVE STE 104
MESA AZ
85209-3326
US

IV. Provider business mailing address

2639 N POWER RD APT 2027
MESA AZ
85215-0007
US

V. Phone/Fax

Practice location:
  • Phone: 480-535-5688
  • Fax:
Mailing address:
  • Phone: 801-369-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: