Provider Demographics
NPI:1124322763
Name:JAVIER AMUSIERRA MD INC
Entity type:Organization
Organization Name:JAVIER AMUSIERRA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:AMU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-743-7340
Mailing Address - Street 1:136 W PEACE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6953
Mailing Address - Country:US
Mailing Address - Phone:559-743-7340
Mailing Address - Fax:559-743-7395
Practice Address - Street 1:372 W CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-2113
Practice Address - Country:US
Practice Address - Phone:559-638-8155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81420174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty