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General NPI Number Information
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NPI Number | 1205091303
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Entity Type | Individual
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Provider Name | JOE CODY LVN
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Gender | Male
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 26883 AUBRIETA ST
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City | MURRIETA
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State | CA
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Zip | 92562-8006
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Country | US
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Telephone | 951-200-3693
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Fax | 951-200-3692
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Provider Business Mailing Address
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Address Line | 29910 MURRIETA HOT SPRINGS RD G234
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City | MURRIETA
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State | CA
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Zip | 92563-3814
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Country | US
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Telephone | 951-200-3693
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Fax | 951-200-3962
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | VN166026
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License Number State | CA
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