Provider Demographics
NPI:1497364061
Name:JARVINA, ERIC (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:JARVINA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S HARVARD BLVD UNIT 401
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2912
Mailing Address - Country:US
Mailing Address - Phone:909-633-3742
Mailing Address - Fax:
Practice Address - Street 1:12655 W JEFFERSON BLVD FL 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7008
Practice Address - Country:US
Practice Address - Phone:310-907-9215
Practice Address - Fax:310-953-3281
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty