Healthcare Provider Details

I. General information

NPI: 1356190102
Provider Name (Legal Business Name): JAVIER CLAVIJO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PARNASSUS AVE
SAN FRANCISCO CA
94143-2210
US

IV. Provider business mailing address

3625 COURBETTE DR
RIVERSIDE CA
92503-4961
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-5800
  • Fax:
Mailing address:
  • Phone: 951-941-4618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.036388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: