Provider Demographics
NPI:1164171724
Name:CERNA, JOSUE N/A (NONE)
Entity Type:Individual
Prefix:
First Name:JOSUE
Middle Name:N/A
Last Name:CERNA
Suffix:
Gender:M
Credentials:NONE
Other - Prefix:
Other - First Name:JOSH
Other - Middle Name:N/A
Other - Last Name:CERNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NONE
Mailing Address - Street 1:1100 TOWN AND COUNTRY RD, STE 1250
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:949-357-2556
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:1100 TOWN AND COUNTRY RD STE 1250
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:949-357-2556
Practice Address - Fax:855-568-2949
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician