Provider Demographics
NPI:1073817540
Name:SIMPSON, JOSHUA DAVID (RN)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 W 4TH ST
Mailing Address - Street 2:APT 303
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2673
Mailing Address - Country:US
Mailing Address - Phone:310-519-0674
Mailing Address - Fax:
Practice Address - Street 1:468 W 4TH ST
Practice Address - Street 2:APT 303
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2673
Practice Address - Country:US
Practice Address - Phone:310-519-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA721023163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse