Healthcare Provider Details

I. General information

NPI: 1265727762
Provider Name (Legal Business Name): NAVARRO PAIN CONTROL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 FENTON STREET C101
CHULA VISTA CA
91914-4543
US

IV. Provider business mailing address

2452 FENTON STREET C101
CHULA VISTA CA
91914-4543
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 TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberC53858
License Number StateCA

VIII. Authorized Official

Name: ROSA M NAVARRO
Title or Position: PRESIDENT / OWNER
Credential: MD
Phone: 619-600-5309