Provider Demographics
NPI:1770190365
Name:NEGRETE, JAVIER JR
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:NEGRETE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 BRYDEN RD APT 6
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1842
Mailing Address - Country:US
Mailing Address - Phone:828-404-4876
Mailing Address - Fax:
Practice Address - Street 1:40 W LONG ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2817
Practice Address - Country:US
Practice Address - Phone:614-321-5156
Practice Address - Fax:614-382-8976
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator