Provider Demographics
NPI:1336331305
Name:JOSHUS A IMPERIO MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JOSHUS A IMPERIO MD A PROFESSIONAL CORPORATION
Other - Org Name:JOSHUA A IMPERIO MD PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:IMPERIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-265-3893
Mailing Address - Street 1:44489 TOWN CENTER WAY # D413
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2723
Mailing Address - Country:US
Mailing Address - Phone:951-265-3893
Mailing Address - Fax:951-769-3054
Practice Address - Street 1:35400 BOB HOPE DR
Practice Address - Street 2:A 201
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1772
Practice Address - Country:US
Practice Address - Phone:951-265-3893
Practice Address - Fax:951-769-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA056083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447273115OtherIND NPI
FLME82679OtherSTATE LICENSE
CAA056083OtherSTATE LICENSE
CAA056083OtherSTATE LICENSE