Provider Demographics
NPI:1417911926
Name:JAVIDAN, NOSRAT (MD)
Entity Type:Individual
Prefix:
First Name:NOSRAT
Middle Name:
Last Name:JAVIDAN
Suffix:
Gender:M
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:PO BOX 6874
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91359-6874
Mailing Address - Country:US
Mailing Address - Phone:805-375-0202
Mailing Address - Fax:805-375-2221
Practice Address - Street 1:1000 NEWBURY RD
Practice Address - Street 2:SUITE # 120
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-3613
Practice Address - Country:US
Practice Address - Phone:805-375-0202
Practice Address - Fax:805-375-2221
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81695207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery