=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487353199
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAVIER SANTOS-GARCIA ASW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2023
-----------------------------------------------------
Last Update Date | 03/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5128 1/2 SANTA MONICA BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90029-2414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-934-0836
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 691 IROLO ST APT 802
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90005-4108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-589-1878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | ASW111037
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------