Provider Demographics
NPI:1427500180
Name:JAVIER, IRENE (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:JAVIER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 CALLE VIBRANTE
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-5727
Mailing Address - Country:US
Mailing Address - Phone:310-259-1137
Mailing Address - Fax:888-463-0671
Practice Address - Street 1:639 CALLE VIBRANTE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-5727
Practice Address - Country:US
Practice Address - Phone:310-259-1137
Practice Address - Fax:888-463-0671
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPPLIED FOR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator