Provider Demographics
NPI:1033810205
Name:VAIL, JOSHUA THOMAS
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:THOMAS
Last Name:VAIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 COORS BLVD NW APT 1409
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3164
Mailing Address - Country:US
Mailing Address - Phone:505-944-5505
Mailing Address - Fax:
Practice Address - Street 1:9180 COORS BLVD NW APT 1409
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3164
Practice Address - Country:US
Practice Address - Phone:505-944-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician