Provider Demographics
NPI:1346530029
Name:VERA, JOSHUA ALLAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALLAN
Last Name:VERA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 DE MARIETTA AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-4408
Mailing Address - Country:US
Mailing Address - Phone:408-431-0156
Mailing Address - Fax:
Practice Address - Street 1:1715 DE MARIETTA AVE
Practice Address - Street 2:APT. 3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-4408
Practice Address - Country:US
Practice Address - Phone:408-431-0156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant