Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | DEN.00203985 | CO |
NPI | 1225415300 |
---|---|
Provider Name | Celine Javanni |
First Address | La Jolla, CA 92037-6036 |
Second Address | Bronx, NY 10457-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2015 |
Last Update Date | 21/06/2019 |