Provider Demographics
NPI:1417122698
Name:SADEKIAN, JOSEPH ESTEPHAN (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ESTEPHAN
Last Name:SADEKIAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 TRAVELODGE DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4126
Mailing Address - Country:US
Mailing Address - Phone:619-441-3149
Mailing Address - Fax:619-441-3185
Practice Address - Street 1:250 TRAVELODGE DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4126
Practice Address - Country:US
Practice Address - Phone:619-441-3149
Practice Address - Fax:619-441-3185
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41901302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization