Provider Demographics
NPI:1083474142
Name:PAREDES, JOSAPHAT
Entity Type:Individual
Prefix:
First Name:JOSAPHAT
Middle Name:
Last Name:PAREDES
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 1:18301 MALDEN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3624
Mailing Address - Country:US
Mailing Address - Phone:818-599-1802
Mailing Address - Fax:
Practice Address - Street 1:18301 MALDEN ST APT 3
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3624
Practice Address - Country:US
Practice Address - Phone:818-599-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01269000376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty