Healthcare Provider Details

I. General information

NPI: 1922467182
Provider Name (Legal Business Name): LYZETTE NAVARRO ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 STODDARD RD STE 600
MODESTO CA
95356-9041
US

IV. Provider business mailing address

5815 STODDARD RD STE 600
MODESTO CA
95356-9041
US

V. Phone/Fax

Practice location:
  • Phone: 209-543-1874
  • Fax: 209-543-1869
Mailing address:
  • Phone: 209-543-1874
  • Fax: 209-543-1869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW66460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: