Healthcare Provider Details

I. General information

NPI: 1679789192
Provider Name (Legal Business Name): JOSANA JOSEPH P.A, D.P.M, P.C.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N PACIFIC COAST HWY STE 1420
EL SEGUNDO CA
90245-5648
US

IV. Provider business mailing address

11420 SANTA MONICA BOULEVARD P.O BOX #252212
LOS ANGELES CA
90025-8978
US

V. Phone/Fax

Practice location:
  • Phone: 310-750-4511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4656
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011385
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15478
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1038
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number007058
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE5885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: