MEDICARE: TIA KAMELE EMI NAVARRO M.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TR0400X	Rehabilitation Psychologist
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1700166980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIA KAMELE EMI NAVARRO M.S.W.

Provider Business Mailing Address
First Line	:	5048 HIGH CREEK DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2334
Country	:	US
Telephone Number	:	808-652-5861
Fax Number	:

Provider Business Practice Location Address
First Line	:	5048 HIGH CREEK DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2334
Country	:	US
Telephone Number	:	808-652-5861
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	04/10/2012

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