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General NPI Number Information
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NPI Number | 1134382013
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Entity Type | Individual
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Provider Name | JOSHUA A. BROAD P.A.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 1314 N NORMA ST
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City | RIDGECREST
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State | CA
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Zip | 93555-2509
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Country | US
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Telephone | 760-446-2935
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Fax | 760-446-2937
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Provider Business Mailing Address
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Address Line | 12380 HESPERIA RD #2
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City | VICTORVILLE
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State | CA
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Zip | 92395-5814
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Country | US
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Telephone | 760-243-4188
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Fax | 714-243-6888
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA19744
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License Number State | CA
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