Healthcare Provider Details

I. General information

NPI: 1740277474
Provider Name (Legal Business Name): ANJALI JAGDISH JAVDEKAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3618 KLEIN CT
SAN JOSE CA
95148-2251
US

IV. Provider business mailing address

3618 KLEIN CT
SAN JOSE CA
95148-2251
US

V. Phone/Fax

Practice location:
  • Phone: 408-274-1337
  • Fax: 408-885-7934
Mailing address:
  • Phone: 408-274-1337
  • Fax: 408-885-7934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number13192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: