Healthcare Provider Details

I. General information

NPI: 1750996492
Provider Name (Legal Business Name): ARIANNA ALEJANDRA NAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 06/11/2023
Certification Date: 06/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PINE AVE
LONG BEACH CA
90802-3041
US

IV. Provider business mailing address

200 PINE AVE
LONG BEACH CA
90802-3041
US

V. Phone/Fax

Practice location:
  • Phone: 562-285-1330
  • Fax:
Mailing address:
  • Phone: 562-285-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: