Healthcare Provider Details

I. General information

NPI: 1811632219
Provider Name (Legal Business Name): JAVIER BORDES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23990 EUCALYPTUS AVE
MORENO VALLEY CA
92553-5504
US

IV. Provider business mailing address

265 SAN JACINTO RIVER RD
LAKE ELSINORE CA
92530-4419
US

V. Phone/Fax

Practice location:
  • Phone: 951-571-4689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: