Provider Demographics
NPI:1588174247
Name:REILLY, JOSHUA JAMES (NMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:JAMES
Last Name:REILLY
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 E SPEEDWAY BLVD APT 406
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1641
Mailing Address - Country:US
Mailing Address - Phone:425-643-0590
Mailing Address - Fax:
Practice Address - Street 1:7700 E SPEEDWAY BLVD APT 406
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1641
Practice Address - Country:US
Practice Address - Phone:425-643-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-1660175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath