Healthcare Provider Details

I. General information

NPI: 1245113927
Provider Name (Legal Business Name): FRANCIS JAVIER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W. HOSPITAL ROAD
FRENCH CAMP CA
95231
US

IV. Provider business mailing address

7178 S RECOVERY RD
FRENCH CAMP CA
95231
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6215
  • Fax:
Mailing address:
  • Phone: 209-468-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1612120525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: