Healthcare Provider Details

I. General information

NPI: 1164076303
Provider Name (Legal Business Name): LILIANNA NAVARRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 S MAIN ST RM 2010
LOS ANGELES CA
90003-1215
US

IV. Provider business mailing address

5850 S MAIN ST RM 2010
LOS ANGELES CA
90003-1215
US

V. Phone/Fax

Practice location:
  • Phone: 323-897-6076
  • Fax:
Mailing address:
  • Phone: 323-897-6076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number134962
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: