Healthcare Provider Details

I. General information

NPI: 1467571844
Provider Name (Legal Business Name): JAVIER TISCARENO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAVIER TISCARENO AGUILAR NP

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 WESTWOOD PLZ
LOS ANGELES CA
90095-1703
US

IV. Provider business mailing address

221 WESTWOOD PLZ
LOS ANGELES CA
90095-1703
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-7897
  • Fax: 310-206-1996
Mailing address:
  • Phone: 310-794-7897
  • Fax: 310-206-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN504249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: