Provider Demographics
NPI:1679893531
Name:BURBOA, JAVIER CHRISTOPHER (PA-C)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:CHRISTOPHER
Last Name:BURBOA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 E ARBOR VITAE ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-3450
Mailing Address - Country:US
Mailing Address - Phone:310-673-8600
Mailing Address - Fax:310-673-9949
Practice Address - Street 1:418 E ARBOR VITAE ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3450
Practice Address - Country:US
Practice Address - Phone:310-673-8600
Practice Address - Fax:310-673-9949
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA20885OtherMEDICAL LICENSE