Provider Demographics
NPI:1972764488
Name:BLACK, JOUISE
Entity type:Individual
Prefix:
First Name:JOUISE
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58923 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-7311
Mailing Address - Country:US
Mailing Address - Phone:760-365-7209
Mailing Address - Fax:760-365-7946
Practice Address - Street 1:58923 BUSINESS CENTER DR
Practice Address - Street 2:SUITE E
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7311
Practice Address - Country:US
Practice Address - Phone:760-365-7209
Practice Address - Fax:760-365-7946
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator