Provider Demographics
NPI:1609426634
Name:ABREGO, JOSHUA KEKONA
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:KEKONA
Last Name:ABREGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 CHARMANT DR UNIT 1409
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4737
Mailing Address - Country:US
Mailing Address - Phone:415-987-4469
Mailing Address - Fax:
Practice Address - Street 1:10680 TREENA ST STE 170
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2443
Practice Address - Country:US
Practice Address - Phone:858-432-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician