Healthcare Provider Details

I. General information

NPI: 1043804511
Provider Name (Legal Business Name): JOSHUA A ACOSTA-DUQUE LCSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 POMONA BLVD
LOS ANGELES CA
90022-1717
US

IV. Provider business mailing address

2025 N D ST
SAN BERNARDINO CA
92405-3913
US

V. Phone/Fax

Practice location:
  • Phone: 323-837-2400
  • Fax: 323-721-2437
Mailing address:
  • Phone: 909-475-8793
  • Fax: 909-886-4958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number99455
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: