Provider Demographics
NPI:1063454916
Name:SILVERSTEIN, JOSEPH DAVID (PA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DAVID
Last Name:SILVERSTEIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 AERICK ST STE 3
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4884
Mailing Address - Country:US
Mailing Address - Phone:310-431-4926
Mailing Address - Fax:805-493-5182
Practice Address - Street 1:645 AERICK ST STE 3
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4884
Practice Address - Country:US
Practice Address - Phone:310-431-4926
Practice Address - Fax:310-431-4529
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16833363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20556OtherMCARE PTAN
CAQ02354Medicare UPIN
CAWPA16833Medicare ID - Type Unspecified