Organization
JAVID TAVARI, D.O., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAVID D TAVARI D.O. (CEO)
(310) 696-0100
Entity
Organization
Contact information
Practice address
11645 WILSHIRE BLVD, SUITE 745, LOS ANGELES, CA 90025-1708
(310) 696-0100
(310) 696-0700
Mailing address
11645 WILSHIRE BLVD, SUITE 745, LOS ANGELES, CA 90025-1708
(310) 696-0100
(310) 696-0700
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
20A6273
CA
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
20A6273
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020A62730
BLUE CROSS
CA
01
—
020A62731
BLUE SHIELD
CA
01
—
FNP2021
OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA
CA
Enumeration date
02/20/2007
Last updated
10/11/2013
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