Provider Demographics
NPI:1689242653
Name:MARTIN, JOSHUA JOHN
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:JOHN
Last Name:MARTIN
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 1:2008 W JACARANDA PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2633
Mailing Address - Country:US
Mailing Address - Phone:714-351-0184
Mailing Address - Fax:
Practice Address - Street 1:2008 W JACARANDA PL
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2633
Practice Address - Country:US
Practice Address - Phone:714-351-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95041844163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse