Healthcare Provider Details

I. General information

NPI: 1366390197
Provider Name (Legal Business Name): ANDREA NAVARRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 CORSON AVE
MODESTO CA
95350-5408
US

IV. Provider business mailing address

3908 BLAKER RD
CERES CA
95307-9679
US

V. Phone/Fax

Practice location:
  • Phone: 209-550-7352
  • Fax:
Mailing address:
  • Phone: 209-287-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: