MEDICARE: JOSEPH I IDONI MPH, PA

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	363AM0700X	Medical Physician Assistant	14788	CA

General Provider Information

NPI Number	:	1841296936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH I IDONI MPH, PA

Provider Business Mailing Address
First Line	:	2535 JENSEN AVE
Second Line	:
City	:	SANGER
State	:	CA
Zip	:	93657-2288
Country	:	US
Telephone Number	:	559-876-6070
Fax Number	:	559-876-6098

Provider Business Practice Location Address
First Line	:	2535 JENSEN AVE
Second Line	:
City	:	SANGER
State	:	CA
Zip	:	93657-2288
Country	:	US
Telephone Number	:	559-876-6070
Fax Number	:	559-876-6098

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	09/05/2008

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