Healthcare Provider Details

I. General information

NPI: 1851751408
Provider Name (Legal Business Name): MARYTERE CARRASQUILLO NAVARRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 COHASSET RD
CHICO CA
95926-2213
US

IV. Provider business mailing address

680 COHASSET RD
CHICO CA
95926-2213
US

V. Phone/Fax

Practice location:
  • Phone: 530-342-4395
  • Fax: 530-894-2325
Mailing address:
  • Phone: 530-342-4395
  • Fax: 530-894-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA162664
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number31916R
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA162664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: