Healthcare Provider Details

I. General information

NPI: 1356207385
Provider Name (Legal Business Name): ANDREW JAVIER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 MOTOR AVE # 403
LOS ANGELES CA
90034-4806
US

IV. Provider business mailing address

3118 S DURANGO AVE APT 5
LOS ANGELES CA
90034-8522
US

V. Phone/Fax

Practice location:
  • Phone: 310-836-8900
  • Fax:
Mailing address:
  • Phone: 562-746-2636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number50238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: