MEDICARE: JOSHUA DAY HENDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1639794829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA DAY HENDERSON

Provider Business Mailing Address
First Line	:	34101 FARENHOLT AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-3338
Country	:	US
Telephone Number	:	818-571-0834
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 836 BOX 542
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09636-0010
Country	:	US
Telephone Number	:	818-571-0834
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	07/08/2025

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Directions to “ JOSHUA DAY HENDERSON ” Practice Location

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