Provider Demographics
NPI:1528590510
Name:WATHEN, JOSHUA (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:WATHEN
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 1:655 EUCLID AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2967
Mailing Address - Country:US
Mailing Address - Phone:619-470-1945
Mailing Address - Fax:619-475-5048
Practice Address - Street 1:655 EUCLID AVE STE 205
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2967
Practice Address - Country:US
Practice Address - Phone:619-470-1945
Practice Address - Fax:619-475-5048
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1587772080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine