Provider Demographics
NPI:1417758244
Name:LONGHAT, JOSHUA (CPSW)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:LONGHAT
Suffix:
Gender:
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1128
Mailing Address - Street 2:
Mailing Address - City:ZUNI
Mailing Address - State:NM
Mailing Address - Zip Code:87327-1128
Mailing Address - Country:US
Mailing Address - Phone:505-870-6479
Mailing Address - Fax:
Practice Address - Street 1:2028 E AZTEC AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4804
Practice Address - Country:US
Practice Address - Phone:505-240-8759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty