Provider Demographics
NPI:1720077662
Name:JOSE, PAULINE JAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:JAVIER
Last Name:JOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-2219
Mailing Address - Country:US
Mailing Address - Phone:323-980-7777
Mailing Address - Fax:323-980-7778
Practice Address - Street 1:3710 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-2219
Practice Address - Country:US
Practice Address - Phone:323-980-7777
Practice Address - Fax:323-980-7778
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA75388Medicare ID - Type Unspecified
CAH41907Medicare UPIN