Provider Demographics
NPI:1467571844
Name:TISCARENO AGUILAR, JAVIER (NP)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:
Last Name:TISCARENO AGUILAR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:JAVIER
Other - Middle Name:
Other - Last Name:TISCARENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:221 WESTWOOD PLZ
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1703
Mailing Address - Country:US
Mailing Address - Phone:310-794-7897
Mailing Address - Fax:310-206-1996
Practice Address - Street 1:221 WESTWOOD PLZ
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1703
Practice Address - Country:US
Practice Address - Phone:310-794-7897
Practice Address - Fax:310-206-1996
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN504249363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care