Healthcare Provider Details

I. General information

NPI: 1275578866
Provider Name (Legal Business Name): JOSHUA MATTHEW DOODY
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 RALSTON AVE
BELMONT CA
94002-1908
US

IV. Provider business mailing address

2607 SOMERSET AVE
CASTRO VALLEY CA
94546-4015
US

V. Phone/Fax

Practice location:
  • Phone: 650-508-3638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: