Provider Demographics
NPI:1669695169
Name:JAVIER, BRENDA JOSE (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOSE
Last Name:JAVIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8403 FALLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3226
Mailing Address - Country:US
Mailing Address - Phone:818-737-6000
Mailing Address - Fax:818-737-6216
Practice Address - Street 1:8403 FALLBROOK AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91304-3226
Practice Address - Country:US
Practice Address - Phone:818-737-6000
Practice Address - Fax:818-737-6216
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53934207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology