Provider Demographics
NPI:1174414478
Name:ANGULO, JAVIER JAY
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:JAY
Last Name:ANGULO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:ANGULO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:119 W TORRANCE BLVD # 100
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3600
Mailing Address - Country:US
Mailing Address - Phone:310-374-3300
Mailing Address - Fax:310-374-3307
Practice Address - Street 1:119 W TORRANCE BLVD # 100
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3600
Practice Address - Country:US
Practice Address - Phone:310-374-3300
Practice Address - Fax:310-374-3307
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X, 106E00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst