Provider Demographics
NPI:1932514957
Name:BALL SEPULVEDA, JAVIER F (PHD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:F
Last Name:BALL SEPULVEDA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 N MARIANNA AVE
Mailing Address - Street 2:APT 107
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-4057
Mailing Address - Country:US
Mailing Address - Phone:626-376-3493
Mailing Address - Fax:
Practice Address - Street 1:1401 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3010
Practice Address - Country:US
Practice Address - Phone:213-742-6059
Practice Address - Fax:213-742-5406
Is Sole Proprietor?:No
Enumeration Date:2014-06-28
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31938103TC0700X
CARPS 2012611225C00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator