Provider Demographics
NPI:1386462968
Name:CLARK, JOSHUA LEE (MSPO)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LEE
Last Name:CLARK
Suffix:
Gender:M
Credentials:MSPO
Other - Prefix:MR
Other - First Name:JOSHUA
Other - Middle Name:LEE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSPO
Mailing Address - Street 1:11048 N CLOUD VIEW PL
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-7070
Mailing Address - Country:US
Mailing Address - Phone:707-292-4089
Mailing Address - Fax:
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO03984224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist