Healthcare Provider Details

I. General information

NPI: 1588323984
Provider Name (Legal Business Name): JOSE M NAVARRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2364 S 2ND ST
EL CENTRO CA
92243-9642
US

IV. Provider business mailing address

2364 S 2ND ST
EL CENTRO CA
92243-9642
US

V. Phone/Fax

Practice location:
  • Phone: 760-332-1468
  • Fax:
Mailing address:
  • Phone: 760-332-1468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: