Basic Information
| Provider Information | |||||||||
| NPI: | 1235291881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAVITZ | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | OSCAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 504 PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934546917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055499555 | ||||||||
| FaxNumber: | 8055490444 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 PEACH ST STE A | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934012871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055434043 | ||||||||
| FaxNumber: | 8055437640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 02/24/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G42639 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | CB218964 | 01 | CA | MEDICARE ID | OTHER |