Provider Demographics
NPI:1487996302
Name:FLATOW, JOSHUA MARK (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:MARK
Last Name:FLATOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 MINDORA DR
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2140
Mailing Address - Country:US
Mailing Address - Phone:424-262-1521
Mailing Address - Fax:
Practice Address - Street 1:320 PINE AVE
Practice Address - Street 2:STE 609
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-2310
Practice Address - Country:US
Practice Address - Phone:562-279-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1487996302174400000X
CA390200000X
CAA1317562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program