Provider Demographics
NPI:1902659097
Name:GHALY, JOSHUA JONAH
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JONAH
Last Name:GHALY
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 1:2812 ARIZONA AVE
Mailing Address - Street 2:APT E
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1530
Mailing Address - Country:US
Mailing Address - Phone:310-735-9999
Mailing Address - Fax:
Practice Address - Street 1:2812 ARIZONA AVE APT E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1530
Practice Address - Country:US
Practice Address - Phone:310-735-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker