Provider Demographics
NPI:1679789192
Name:JOSEPH, JOSANA (PA, DPM)
Entity Type:Individual
Prefix:MS
First Name:JOSANA
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PA, DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 DEL AMO BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5445 DEL AMO BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2761
Practice Address - Country:US
Practice Address - Phone:562-867-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007058213E00000X
CT1038213E00000X
NY011385363A00000X
CT4656363A00000X
CAE5885213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant