Provider Demographics
NPI:1285021030
Name:RUNLEY, JOSH
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:RUNLEY
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 1:660 S GLASSELL ST
Mailing Address - Street 2:APT 67
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-3001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:660 S GLASSELL ST
Practice Address - Street 2:APT 67
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3001
Practice Address - Country:US
Practice Address - Phone:760-975-8348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer