Healthcare Provider Details
I. General information
NPI: 1386182541
Provider Name (Legal Business Name): PARITA JAVIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
8332 W THUNDERBIRD RD
PEORIA AZ
85381-4822
US
IV. Provider business mailing address
10155 W AVENIDA DEL REY
PEORIA AZ
85383-1430
US
V. Phone/Fax
- Phone: 623-776-3006
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | AP9898 |
| License Number State | AZ |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: