Provider Demographics
NPI:1922747286
Name:JOSH NATHAN MD PC
Entity Type:Organization
Organization Name:JOSH NATHAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-230-9355
Mailing Address - Street 1:130 S ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2104
Mailing Address - Country:US
Mailing Address - Phone:510-230-9355
Mailing Address - Fax:
Practice Address - Street 1:130 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2104
Practice Address - Country:US
Practice Address - Phone:510-230-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center