Provider Demographics
NPI:1407010473
Name:JAVIER, VETH (LAC)
Entity Type:Individual
Prefix:
First Name:VETH
Middle Name:
Last Name:JAVIER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4536
Mailing Address - Country:US
Mailing Address - Phone:818-729-8540
Mailing Address - Fax:818-450-0652
Practice Address - Street 1:2907 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4536
Practice Address - Country:US
Practice Address - Phone:818-729-8540
Practice Address - Fax:818-450-0652
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4414171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist