Provider Demographics
NPI:1174846729
Name:VANDERHOOF, JOSHUA REX
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:REX
Last Name:VANDERHOOF
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 1:5300 VISTA REAL DR
Mailing Address - Street 2:TRL 46
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-7803
Mailing Address - Country:US
Mailing Address - Phone:575-635-6916
Mailing Address - Fax:
Practice Address - Street 1:5300 VISTA REAL DR
Practice Address - Street 2:TRL 46
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-7803
Practice Address - Country:US
Practice Address - Phone:575-635-6916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator