Provider Demographics
NPI:1376754242
Name:ROSS, JOSHUA WILLIAM (SFIDC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:WILLIAM
Last Name:ROSS
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W. VINEYARD AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036
Mailing Address - Country:US
Mailing Address - Phone:805-824-9369
Mailing Address - Fax:
Practice Address - Street 1:NAVAL AMBULATORY CARE CLINIC
Practice Address - Street 2:162 1ST STREET BUILDING 1402
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93043-0001
Practice Address - Country:US
Practice Address - Phone:805-982-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman