Provider Demographics
NPI:1760825467
Name:BEARD, JOSHUA ANDREW (IDC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ANDREW
Last Name:BEARD
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30949 MOONFLOWER LANE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563
Mailing Address - Country:US
Mailing Address - Phone:760-845-9508
Mailing Address - Fax:
Practice Address - Street 1:30949 MOONFLOWER LN
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-7952
Practice Address - Country:US
Practice Address - Phone:760-845-9508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman