Provider Demographics
NPI:1215031778
Name:JAVELLANA, CARMELA J (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMELA
Middle Name:J
Last Name:JAVELLANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 W 3100 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5734
Mailing Address - Country:US
Mailing Address - Phone:801-268-0333
Mailing Address - Fax:801-268-3777
Practice Address - Street 1:13 W 3100 S
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5734
Practice Address - Country:US
Practice Address - Phone:801-268-0333
Practice Address - Fax:801-268-3777
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT280094-12052084P0800X
UT502995912052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107008135102OtherIHC