Healthcare Provider Details

I. General information

NPI: 1841567104
Provider Name (Legal Business Name): JOSHUA JOSEPH TARTAGLIONE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MAIN ST
EL CAJON CA
92020-4007
US

IV. Provider business mailing address

9500 GILMAN DR # 9116A UC SAN DIEGO, PSYCHIATRY RESIDENCY PROGRAM
LA JOLLA CA
92093-5004
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2498
  • Fax:
Mailing address:
  • Phone: 858-534-4040
  • Fax: 858-822-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A13109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: