Provider Demographics
NPI:1790992816
Name:JAVIER, EDGARDO A (CSFA)
Entity Type:Individual
Prefix:MR
First Name:EDGARDO
Middle Name:A
Last Name:JAVIER
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 LOVELAND ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-3921
Mailing Address - Country:US
Mailing Address - Phone:504-669-6270
Mailing Address - Fax:
Practice Address - Street 1:5241 LOVELAND ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3921
Practice Address - Country:US
Practice Address - Phone:504-669-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACN524521363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN524521OtherNAT CENTER FOR C TECHS