Provider Demographics
NPI:1568662963
Name:JOSEPH, JOACHIM OLAWALE (CNA)
Entity Type:Individual
Prefix:
First Name:JOACHIM
Middle Name:OLAWALE
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2514
Mailing Address - Country:US
Mailing Address - Phone:510-437-2363
Mailing Address - Fax:510-437-2364
Practice Address - Street 1:2620 26TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1907
Practice Address - Country:US
Practice Address - Phone:510-437-2363
Practice Address - Fax:510-437-2364
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist