Provider Demographics
NPI:1063847424
Name:SALTHOUSE, JOSEPH WILLIAM (LVN)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:SALTHOUSE
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 N MAIN ST
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-1409
Mailing Address - Country:US
Mailing Address - Phone:951-738-4200
Mailing Address - Fax:
Practice Address - Street 1:629 N MAIN ST
Practice Address - Street 2:SUITE C-3
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-1409
Practice Address - Country:US
Practice Address - Phone:951-738-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN152085164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse