Provider Demographics
NPI:1134253180
Name:CONTRERAS, JOSEPH JOHN (PA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6065 N 1ST ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5469
Mailing Address - Country:US
Mailing Address - Phone:559-446-0285
Mailing Address - Fax:559-446-1646
Practice Address - Street 1:6065 N 1ST ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5469
Practice Address - Country:US
Practice Address - Phone:559-446-0285
Practice Address - Fax:559-446-1646
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 13218363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical