MEDICARE: MR. CARLOS F JAVIER III

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	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1861777138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARLOS F JAVIER III

Provider Business Mailing Address
First Line	:	145 BROKEN TEE DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-8324
Country	:	US
Telephone Number	:	702-454-1203
Fax Number	:	702-454-1203

Provider Business Practice Location Address
First Line	:	3625 ROSEWOOD DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3261
Country	:	US
Telephone Number	:	702-454-0532
Fax Number	:	702-454-1203

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

Provider Enumeration Date	:	10/18/2011
Last Update Date	:	10/18/2011

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