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General NPI Number Information
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NPI Number | 1336964105
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Entity Type | Individual
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Provider Name | JOSHUA PAUL FLADGER
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Gender | Male
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 1316 APACHE AVE
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City | SANTA FE
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State | NM
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Zip | 87505-3212
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Country | US
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Telephone | 480-255-4766
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Fax |
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Provider Business Mailing Address
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Address Line | 20548 VENTURA BLVD APT 407
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-6472
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Country | US
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Telephone |
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Fax |
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 1770
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License Number State | NM
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