Provider Demographics
NPI:1063900884
Name:JOSHUA X, DARLENE
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:JOSHUA X
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 HOLLYRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-4000
Mailing Address - Country:US
Mailing Address - Phone:725-400-4098
Mailing Address - Fax:725-605-5874
Practice Address - Street 1:5304 HOLLYRIDGE ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-4000
Practice Address - Country:US
Practice Address - Phone:702-400-4089
Practice Address - Fax:725-605-5874
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician