Provider Demographics
NPI:1811060908
Name:KRUSE, JOSHUA MICHAEL (MA, MA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MICHAEL
Last Name:KRUSE
Suffix:
Gender:M
Credentials:MA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 N MOUNTAIN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3659
Mailing Address - Country:US
Mailing Address - Phone:909-579-8100
Mailing Address - Fax:
Practice Address - Street 1:934 N MOUNTAIN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3659
Practice Address - Country:US
Practice Address - Phone:909-579-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program