Provider Demographics
NPI:1457555377
Name:CONROE, JOSHUA
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:CONROE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 E SHAW AVE
Mailing Address - Street 2:STE. #102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7620
Mailing Address - Country:US
Mailing Address - Phone:559-226-0167
Mailing Address - Fax:559-226-1559
Practice Address - Street 1:83 E SHAW AVE
Practice Address - Street 2:STE. #102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7620
Practice Address - Country:US
Practice Address - Phone:559-226-0167
Practice Address - Fax:559-226-1559
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator