Provider Demographics
NPI:1689756546
Name:ATIBA, JOSHUA OLAJIDE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:OLAJIDE
Last Name:ATIBA
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:PO BOX 2229
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95001-2229
Mailing Address - Country:US
Mailing Address - Phone:707-631-0921
Mailing Address - Fax:
Practice Address - Street 1:1380 SAN ANDREAS RD
Practice Address - Street 2:
Practice Address - City:LA SELVA BEACH
Practice Address - State:CA
Practice Address - Zip Code:95076-9636
Practice Address - Country:US
Practice Address - Phone:831-761-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA048957207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology