Healthcare Provider Details

I. General information

NPI: 1104378348
Provider Name (Legal Business Name): JAVIER MARGARITO JR. MA, ATC, CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 W FREMONT RD
LOS ALTOS HILLS CA
94022-1919
US

IV. Provider business mailing address

26800 W FREMONT RD
LOS ALTOS HILLS CA
94022-1919
US

V. Phone/Fax

Practice location:
  • Phone: 650-209-3131
  • Fax:
Mailing address:
  • Phone: 650-209-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number24271
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberBOC 2000002355
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: