Basic Information
| Provider Information | |||||||||
| NPI: | 1851026553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAVIER | ||||||||
| FirstName: | TRISTAN LOUISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2869 ORANGE GROVE TER | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956487645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166262864 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3900 GARFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956086647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164816455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2022 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.