Provider Demographics
NPI:1083007033
Name:ISQUIERDO, JOSEPH DANIEL
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DANIEL
Last Name:ISQUIERDO
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 1:1212 N. CALIFORNIA STREET
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202
Mailing Address - Country:US
Mailing Address - Phone:209-463-0870
Mailing Address - Fax:209-468-9611
Practice Address - Street 1:620 N AURORA ST. SUITE # 6
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202
Practice Address - Country:US
Practice Address - Phone:209-616-7518
Practice Address - Fax:209-463-9611
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)