Provider Demographics
NPI:1639274616
Name:JAVIER, MARILYN GARCIA (NP)
Entity Type:Individual
Prefix:MISS
First Name:MARILYN
Middle Name:GARCIA
Last Name:JAVIER
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:9828 NATURE TRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757
Mailing Address - Country:US
Mailing Address - Phone:916-685-7410
Mailing Address - Fax:916-685-7410
Practice Address - Street 1:1041 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95211
Practice Address - Country:US
Practice Address - Phone:209-946-2315
Practice Address - Fax:209-946-3001
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA13145363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P26704Medicare UPIN