Healthcare Provider Details

I. General information

NPI: 1891146551
Provider Name (Legal Business Name): JAVIER OSCAR ANDA P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S ALVARADO ST
LOS ANGELES CA
90057-2904
US

IV. Provider business mailing address

510 S ALVARADO ST
LOS ANGELES CA
90057-2904
US

V. Phone/Fax

Practice location:
  • Phone: 213-483-3600
  • Fax:
Mailing address:
  • Phone: 213-483-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: