Healthcare Provider Details

I. General information

NPI: 1134979743
Provider Name (Legal Business Name): REESHA JAVAID FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25115 AVENUE STANFORD # A104
VALENCIA CA
91355-1290
US

IV. Provider business mailing address

21725 SHALLOT CT
SAUGUS CA
91350-1638
US

V. Phone/Fax

Practice location:
  • Phone: 661-468-7405
  • Fax:
Mailing address:
  • Phone: 661-309-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01240875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: