Provider Demographics
NPI:1841566122
Name:NOGA, JOHN IOSEFO I
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:IOSEFO
Last Name:NOGA
Suffix:I
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 1:210 TACOMA ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-9370
Mailing Address - Country:US
Mailing Address - Phone:541-476-3302
Mailing Address - Fax:
Practice Address - Street 1:210 TACOMA ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-9370
Practice Address - Country:US
Practice Address - Phone:541-476-3302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health