Provider Demographics
NPI:1649929233
Name:NORMAN, JOSHUA SCOTT
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SCOTT
Last Name:NORMAN
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 1:1920 COLINA SALIDA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3652
Mailing Address - Country:US
Mailing Address - Phone:949-813-3496
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DRIVE, LANE 154
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5133
Practice Address - Country:US
Practice Address - Phone:650-723-6661
Practice Address - Fax:650-498-6205
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program