Provider Demographics
NPI:1912011560
Name:CORBEN, JOSHUA ADAM (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ADAM
Last Name:CORBEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23206 LYONS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2667
Mailing Address - Country:US
Mailing Address - Phone:661-259-2168
Mailing Address - Fax:661-259-3568
Practice Address - Street 1:23206 LYONS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2667
Practice Address - Country:US
Practice Address - Phone:661-259-2168
Practice Address - Fax:661-259-3568
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11995152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0119950Medicaid
CAMC0840896OtherDEA#