Provider Demographics
NPI:1346828142
Name:BROSCO, JOIA HORDATT
Entity type:Individual
Prefix:
First Name:JOIA
Middle Name:HORDATT
Last Name:BROSCO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 MONTE VISTA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4920
Mailing Address - Country:US
Mailing Address - Phone:305-788-1934
Mailing Address - Fax:
Practice Address - Street 1:1411 EAST 31ST STREET
Practice Address - Street 2:QIC 22123
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1092
Practice Address - Country:US
Practice Address - Phone:510-437-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA194129207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine