Healthcare Provider Details

I. General information

NPI: 1225858509
Provider Name (Legal Business Name): JOSHUA DAVID JOHN GOMEZ-CASTRO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 E HERNDON AVE
FRESNO CA
93720-3309
US

IV. Provider business mailing address

3700 LOMA VISTA PKWY APT 3903
CLOVIS CA
93619-9861
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-3000
  • Fax:
Mailing address:
  • Phone: 805-602-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95322885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: