Healthcare Provider Details

I. General information

NPI: 1528405503
Provider Name (Legal Business Name): JOSHUA SETH PHILP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 MERRILL DR
SAN JOSE CA
95124-5919
US

IV. Provider business mailing address

1695 MERRILL DR
SAN JOSE CA
95124-5919
US

V. Phone/Fax

Practice location:
  • Phone: 585-802-2098
  • Fax:
Mailing address:
  • Phone: 585-802-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number02231981J
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: