Provider Demographics
NPI:1447294715
Name:JAVAHERIAN, JASMIN (DO)
Entity type:Individual
Prefix:DR
First Name:JASMIN
Middle Name:
Last Name:JAVAHERIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16661 VENTURA BLVD STE 815
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1996
Mailing Address - Country:US
Mailing Address - Phone:818-501-3366
Mailing Address - Fax:818-906-7961
Practice Address - Street 1:16661 VENTURA BLVD STE 815
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1996
Practice Address - Country:US
Practice Address - Phone:818-501-3366
Practice Address - Fax:818-906-7961
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX80830Medicaid
CA00AX80830Medicaid
CAW20A8083AMedicare ID - Type Unspecified