Provider Demographics
NPI:1629696042
Name:JAVIER, ASHLIE RENEE
Entity Type:Individual
Prefix:
First Name:ASHLIE
Middle Name:RENEE
Last Name:JAVIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 CALLE ESTRELLA
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-4080
Mailing Address - Country:US
Mailing Address - Phone:909-282-9553
Mailing Address - Fax:
Practice Address - Street 1:1266 CALLE ESTRELLA
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-4080
Practice Address - Country:US
Practice Address - Phone:909-282-9553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner