Provider Demographics
NPI:1235774027
Name:PHIFER, JOSHUA THOMAS (RDN, CDCES, MCHES)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:THOMAS
Last Name:PHIFER
Suffix:
Gender:M
Credentials:RDN, CDCES, MCHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 W 11TH ST UNIT 15
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-3358
Mailing Address - Country:US
Mailing Address - Phone:303-720-8010
Mailing Address - Fax:888-388-1711
Practice Address - Street 1:473 E. CARNEGIE DRIVE
Practice Address - Street 2:200
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:303-720-8010
Practice Address - Fax:888-388-1711
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27630174H00000X
CA86117763133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator