Provider Demographics
NPI:1174408793
Name:NG, JOSHUA TREVOR
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TREVOR
Last Name:NG
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 1:3242 COWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-4712
Mailing Address - Country:US
Mailing Address - Phone:510-529-8785
Mailing Address - Fax:510-529-8785
Practice Address - Street 1:3242 COWELL BLVD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-4712
Practice Address - Country:US
Practice Address - Phone:510-529-8785
Practice Address - Fax:510-529-8785
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion