Healthcare Provider Details

I. General information

NPI: 1033208608
Provider Name (Legal Business Name): BENJAMIN NAVARRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12751 HARBOR BLVD
GARDEN GROVE CA
92840-5800
US

IV. Provider business mailing address

12751 HARBOR BLVD
GARDEN GROVE CA
92840-5800
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-7852
  • Fax: 714-636-0928
Mailing address:
  • Phone: 714-636-7852
  • Fax: 714-636-0928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA39177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: