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General NPI Number Information
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NPI Number | 1295034395
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Entity Type | Organization
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Legal Business Name | JOSHUA JORDAN MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 3275 TWEEDY BLVD
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City | SOUTH GATE
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State | CA
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Zip | 90280-4348
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Country | US
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Telephone | 714-262-5136
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Fax | 310-499-5261
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Provider Business Mailing Address
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Address Line | PO BOX 27851
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City | ANAHEIM
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State | CA
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Zip | 92809-0128
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Country | US
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Telephone | 714-262-5136
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Fax | 310-499-5261
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROYA MASOUD
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Credential | DO
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Telephone | 714-262-5136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A10231
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License Number State | CA
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