Provider Demographics
NPI:1922563972
Name:NERENBERG, JOSH (LAC)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:NERENBERG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10459 SAN DIEGO MISSION RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2101
Mailing Address - Country:US
Mailing Address - Phone:619-244-7648
Mailing Address - Fax:
Practice Address - Street 1:10459 SAN DIEGO MISSION RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2101
Practice Address - Country:US
Practice Address - Phone:619-244-7648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15942171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist