Healthcare Provider Details

I. General information

NPI: 1104498922
Provider Name (Legal Business Name): JOSHUA PAPAGEORGES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 LAUREL HILLS DR
SACRAMENTO CA
95841-3105
US

IV. Provider business mailing address

3468 FRANCIS DR
LOOMIS CA
95650-8869
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-5100
  • Fax:
Mailing address:
  • Phone: 949-429-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150421
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: