Basic Information
| Provider Information | |||||||||
| NPI: | 1972794485 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAVONILLO | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICENSED PSYCH TECH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 REDONDO AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908062325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622562900 | ||||||||
| FaxNumber: | 5622900074 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 REDONDO AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908062325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622562900 | ||||||||
| FaxNumber: | 5622900074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2007 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 167G00000X | PT34326 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician | 374700000X | N | Nursing Service Related Providers | Technician |
No ID Information.