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General NPI Number Information
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NPI Number | 1578124871
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Entity Type | Organization
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Legal Business Name | JAVIER JARDON, M.D., MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 4131 SLAUSON AVE
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City | MAYWOOD
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State | CA
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Zip | 90270
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Country | US
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Telephone | 323-749-8100
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Fax | 323-749-8101
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Provider Business Mailing Address
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Address Line | PO BOX 762
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City | MAYWOOD
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State | CA
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Zip | 90270
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Country | US
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Telephone | 323-749-8100
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Fax | 323-749-8101
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAVIER A JARDON
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Credential | MD
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Telephone | 323-749-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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