Healthcare Provider Details

I. General information

NPI: 1871812537
Provider Name (Legal Business Name): VIRGINIA NAVARRO BEAS IMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD # 115
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4650 W SUNSET BLVD # 115
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-6806
  • Fax: 323-361-8342
Mailing address:
  • Phone: 323-361-6806
  • Fax: 323-361-8342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF62777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: