Provider Demographics
NPI:1235330440
Name:NATHAN A JAVARI DPM
Entity Type:Organization
Organization Name:NATHAN A JAVARI DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:AFSHIN
Authorized Official - Last Name:JAVARI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-231-7745
Mailing Address - Street 1:231 WEST VERNON AVE # 109
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037
Mailing Address - Country:US
Mailing Address - Phone:323-231-7445
Mailing Address - Fax:
Practice Address - Street 1:231 WEST VERNON AVE # 109
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037
Practice Address - Country:US
Practice Address - Phone:323-231-7445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4456213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E44560Medicaid
CAW18787Medicare ID - Type Unspecified
CA000E44560Medicaid
CAU86493Medicare UPIN