Provider Demographics
NPI:1578124871
Name:JAVIER JARDON, M.D., MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JAVIER JARDON, M.D., MEDICAL CORPORATION
Other - Org Name:OPHTHALMOLOGY EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:A
Authorized Official - Last Name:JARDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-749-8100
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270
Mailing Address - Country:US
Mailing Address - Phone:323-749-8100
Mailing Address - Fax:323-749-8101
Practice Address - Street 1:4131 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270
Practice Address - Country:US
Practice Address - Phone:323-749-8100
Practice Address - Fax:323-749-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty