Healthcare Provider Details

I. General information

NPI: 1699481101
Provider Name (Legal Business Name): MR. JOSHUA ALLEN POOL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17270 ROOSEVELT ST
RIVERSIDE CA
92508-9523
US

IV. Provider business mailing address

11918 RUDBECKIA CIR
MORENO VALLEY CA
92557-8623
US

V. Phone/Fax

Practice location:
  • Phone: 951-300-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-GHEKSI
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: