Healthcare Provider Details

I. General information

NPI: 1184046450
Provider Name (Legal Business Name): ALICIA NAVARRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 BEACH BOULEVARD SUITE 245
BUENA PARK CA
90621-4031
US

IV. Provider business mailing address

1502 E CRESTLANE AVE
ANAHEIM CA
92805-1205
US

V. Phone/Fax

Practice location:
  • Phone: 714-736-0231
  • Fax: 714-736-0895
Mailing address:
  • Phone: 714-736-0231
  • Fax: 714-736-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF77910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: