Provider Demographics
NPI:1720864598
Name:MCCRITTY, JOSHUA B
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:B
Last Name:MCCRITTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 E ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3660
Mailing Address - Country:US
Mailing Address - Phone:510-330-7932
Mailing Address - Fax:
Practice Address - Street 1:2410 E ST APT 4
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3660
Practice Address - Country:US
Practice Address - Phone:510-330-7932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA93-3207783Medicaid