Provider Demographics
NPI:1457329674
Name:PRESTON, JOSEPH C (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:PRESTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W LA VETA AVE STE 750
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4312
Mailing Address - Country:US
Mailing Address - Phone:714-361-6600
Mailing Address - Fax:714-919-8804
Practice Address - Street 1:1010 W LA VETA AVE STE 750
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4312
Practice Address - Country:US
Practice Address - Phone:714-361-6600
Practice Address - Fax:714-919-8804
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80997207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110198149OtherRAIL ROAD MEDICARE - PROVIDER PTAN
CAW1514OtherMEDICARE PTAN - TYPE 2
1912919804OtherNPI - TYPE 2
CA1912919804Medicaid
CACG5665OtherRAIL ROAD MEDICARE - GROUP PTAN
CAG54416Medicare UPIN
CACG5665OtherRAIL ROAD MEDICARE - GROUP PTAN