Provider Demographics
NPI:1205091303
Name:CODY, JOE (LVN)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:CODY
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29910 MURRIETA HOT SPRINGS RD
Mailing Address - Street 2:G234
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3814
Mailing Address - Country:US
Mailing Address - Phone:951-200-3693
Mailing Address - Fax:951-200-3962
Practice Address - Street 1:26883 AUBRIETA ST
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8006
Practice Address - Country:US
Practice Address - Phone:951-200-3693
Practice Address - Fax:951-200-3692
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN166026164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse