Healthcare Provider Details

I. General information

NPI: 1497660294
Provider Name (Legal Business Name): JOSHUA DANIEL MOULTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 S AVENUE A
YUMA AZ
85365
US

IV. Provider business mailing address

1339 E 23RD PL
YUMA AZ
85365-2525
US

V. Phone/Fax

Practice location:
  • Phone: 928-640-6580
  • Fax:
Mailing address:
  • Phone: 207-408-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberAZ00020806
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: