Healthcare Provider Details

I. General information

NPI: 1518506500
Provider Name (Legal Business Name): JOSHUA LEE HAWKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GREENLEY RD
SONORA CA
95370-5200
US

IV. Provider business mailing address

PO BOX 3099
SONORA CA
95370-3099
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95208377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: