Healthcare Provider Details

I. General information

NPI: 1700534666
Provider Name (Legal Business Name): JAY M JAVUREK NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 EL MONTE DR
THOUSAND OAKS CA
91362-1820
US

IV. Provider business mailing address

1990 EL MONTE DR
THOUSAND OAKS CA
91362-1820
US

V. Phone/Fax

Practice location:
  • Phone: 805-907-6893
  • Fax:
Mailing address:
  • Phone: 805-907-6893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61645310
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number600165
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9181723
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: