Basic Information
| Provider Information | |||||||||
| NPI: | 1902471204 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAVIER | ||||||||
| FirstName: | ELENA | ||||||||
| MiddleName: | AGUILAR | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 768 VALLEY WAY | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950515658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086584640 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1171 HOMESTEAD RD STE 250 | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950505485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083202590 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2021 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 21333 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.