Healthcare Provider Details

I. General information

NPI: 1457702524
Provider Name (Legal Business Name): NAVID JAVAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 11/10/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY CIR
TURLOCK CA
95382-3200
US

IV. Provider business mailing address

1 UNIVERSITY CIR
TURLOCK CA
95382-3200
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-3396
  • Fax: 209-667-3195
Mailing address:
  • Phone: 209-667-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberFJ8171073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: