Provider Demographics
NPI:1699149898
Name:JOSHUA PAL MD A PROFESSIONAL CORP
Entity type:Organization
Organization Name:JOSHUA PAL MD A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:SAMEER
Authorized Official - Last Name:PAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-777-3520
Mailing Address - Street 1:PO BOX 711403
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92072-1403
Mailing Address - Country:US
Mailing Address - Phone:617-777-3520
Mailing Address - Fax:
Practice Address - Street 1:2023 W VISTA WAY STE E
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6030
Practice Address - Country:US
Practice Address - Phone:760-842-8796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSHUA PAL MD A PROFESSIONAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-25
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104765174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN
CA=========OtherEIN