MEDICARE: MR. JAVIER ANDRES DONAHOE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	95074	CA

General Provider Information

NPI Number	:	1437326428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAVIER ANDRES DONAHOE

Provider Business Mailing Address
First Line	:	5849 CROCKER ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1311
Country	:	US
Telephone Number	:	323-234-4445
Fax Number	:	323-234-4477

Provider Business Practice Location Address
First Line	:	5849 CROCKER ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1311
Country	:	US
Telephone Number	:	323-234-4445
Fax Number	:	323-234-4477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	09/16/2016

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Directions to “ MR. JAVIER ANDRES DONAHOE ” Practice Location

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