Provider Demographics
NPI:1790311769
Name:JOE, ADRIENNE ALMADA
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:ALMADA
Last Name:JOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:RHEA
Other - Last Name:ALMADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23141 MOULTON PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1241
Mailing Address - Country:US
Mailing Address - Phone:949-215-7575
Mailing Address - Fax:
Practice Address - Street 1:23141 MOULTON PKWY STE 108
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1241
Practice Address - Country:US
Practice Address - Phone:949-215-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-21
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95012683363LW0102X
CA236086367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health