Provider Demographics
NPI:1295614170
Name:LACSA, JOSHUA CHRISTIAN MAGAT
Entity type:Individual
Prefix:
First Name:JOSHUA CHRISTIAN
Middle Name:MAGAT
Last Name:LACSA
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 1:3201 DREW ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-2306
Mailing Address - Country:US
Mailing Address - Phone:213-810-7135
Mailing Address - Fax:
Practice Address - Street 1:500 N LORAINE AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2964
Practice Address - Country:US
Practice Address - Phone:626-963-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty