Healthcare Provider Details

I. General information

NPI: 1730594078
Provider Name (Legal Business Name): JOSHUA CLEMENTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 TENAYA DR
MODESTO CA
95354-3930
US

IV. Provider business mailing address

737 W CHILDS AVE
MERCED CA
95341-6805
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-6766
  • Fax: 209-576-6770
Mailing address:
  • Phone: 209-385-5481
  • Fax: 209-383-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number51712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: