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General NPI Number Information
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NPI Number | 1679609622
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Entity Type | Organization
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Legal Business Name | LEILIE JAVAN, M.D., A MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 425 HAALAND DR SUITE 203
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-5229
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Country | US
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Telephone | 805-381-9800
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Fax | 805-496-8480
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Provider Business Mailing Address
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Address Line | 425 HAALAND DR SUITE 203
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-5229
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Country | US
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Telephone | 805-381-9800
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Fax | 805-496-8480
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DR. LEILIE J JAVAN
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Credential | M.D.
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Telephone | 805-495-0551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | G861010
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License Number State | CA
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