Provider Demographics
NPI:1568647022
Name:JAVAHERY, JILL HOLLY (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:HOLLY
Last Name:JAVAHERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 LONG BEACH BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2685
Mailing Address - Country:US
Mailing Address - Phone:562-997-1144
Mailing Address - Fax:562-997-9881
Practice Address - Street 1:3918 LONG BEACH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2685
Practice Address - Country:US
Practice Address - Phone:562-997-1144
Practice Address - Fax:562-997-9881
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist