Provider Demographics
NPI:1730767336
Name:BROCK, JOSHUA LEE
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:LEE
Last Name:BROCK
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 1:3778 TAYRIEN ST SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8978
Mailing Address - Country:US
Mailing Address - Phone:505-569-0069
Mailing Address - Fax:
Practice Address - Street 1:3778 TAYRIEN ST SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8978
Practice Address - Country:US
Practice Address - Phone:505-569-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information