Healthcare Provider Details

I. General information

NPI: 1679316822
Provider Name (Legal Business Name): JOA DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9955 CARMEL MOUNTAIN RD STE F1
SAN DIEGO CA
92129-2815
US

IV. Provider business mailing address

9955 CARMEL MOUNTAIN RD STE F1
SAN DIEGO CA
92129-2815
US

V. Phone/Fax

Practice location:
  • Phone: 858-324-0033
  • Fax:
Mailing address:
  • Phone: 858-324-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SOPHIE YU
Title or Position: MANAGER
Credential:
Phone: 858-789-0607