Provider Demographics
NPI:1841296936
Name:IDONI, JOSEPH I (MPH, PA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:I
Last Name:IDONI
Suffix:
Gender:M
Credentials:MPH, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 JENSEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2288
Mailing Address - Country:US
Mailing Address - Phone:559-876-6070
Mailing Address - Fax:559-876-6098
Practice Address - Street 1:2535 JENSEN AVE
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2288
Practice Address - Country:US
Practice Address - Phone:559-876-6070
Practice Address - Fax:559-876-6098
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14788363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA147882Medicare PIN
CAZZZ04986ZMedicare Oscar/Certification