Provider Demographics
NPI:1447729736
Name:PFEIFFER, JOSHUA JUSTIN (PA-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JUSTIN
Last Name:PFEIFFER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-0753
Mailing Address - Country:US
Mailing Address - Phone:602-334-9524
Mailing Address - Fax:
Practice Address - Street 1:1272 MONTE VISTA CT
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2435
Practice Address - Country:US
Practice Address - Phone:602-334-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA56229363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant