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General NPI Number Information
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NPI Number | 1720836083
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Entity Type | Individual
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Provider Name | JOEL JUSTIN CORVERA
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Gender | Male
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Dates
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Enumeration Date | 05/10/2024
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 119 S LOCUST ST UNIT B
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City | VISALIA
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State | CA
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Zip | 93291-6251
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Country | US
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Telephone | 559-366-7177
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Fax | 866-421-1361
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Provider Business Mailing Address
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Address Line | 1700 S COURT ST STE F
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City | VISALIA
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State | CA
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Zip | 93277-4931
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Country | US
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Telephone | 559-734-9244
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Fax | 559-734-6932
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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 | 64454
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License Number State | CA
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