Provider Demographics
NPI:1861915399
Name:SIERRA, JOSHUA ELEAZAR
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ELEAZAR
Last Name:SIERRA
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 1:250 ASHEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KENLY
Mailing Address - State:NC
Mailing Address - Zip Code:27542-8820
Mailing Address - Country:US
Mailing Address - Phone:910-489-2355
Mailing Address - Fax:
Practice Address - Street 1:114 SCORPION DR
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9101
Practice Address - Country:US
Practice Address - Phone:910-371-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty