Provider Demographics
NPI:1972794485
Name:JAVONILLO, TAMMY ANN (LICENSED PSYCH TECH)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:ANN
Last Name:JAVONILLO
Suffix:
Gender:F
Credentials:LICENSED PSYCH TECH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2600 REDONDO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2325
Mailing Address - Country:US
Mailing Address - Phone:562-256-2900
Mailing Address - Fax:562-290-0074
Practice Address - Street 1:2600 REDONDO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2325
Practice Address - Country:US
Practice Address - Phone:562-256-2900
Practice Address - Fax:562-290-0074
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 374700000X
CAPT34326167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No374700000XNursing Service Related ProvidersTechnician