Healthcare Provider Details

I. General information

NPI: 1083691802
Provider Name (Legal Business Name): ROSA M NAVARRO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 FENTON ST SUITE C101
CHULA VISTA CA
91914-3599
US

IV. Provider business mailing address

2452 FENTON ST SUITE C101
CHULA VISTA CA
91914-3599
US

V. Phone/Fax

Practice location:
  • Phone: 619-600-5309
  • Fax: 619-655-4700
Mailing address:
  • Phone: 619-600-5309
  • Fax: 619-655-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number01055554A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberC53858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: