Healthcare Provider Details

I. General information

NPI: 1609171479
Provider Name (Legal Business Name): MISS OLIVIA JAMILE NAVARRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 BEECHTREE CT
MENTONE CA
92359-1603
US

IV. Provider business mailing address

2107 BEECHTREE CT
MENTONE CA
92359-1603
US

V. Phone/Fax

Practice location:
  • Phone: 909-725-1413
  • Fax:
Mailing address:
  • Phone: 909-725-1413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: