Healthcare Provider Details

I. General information

NPI: 1396206058
Provider Name (Legal Business Name): NICOLE CELESTE NAVARRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23990 EUCALYPTUS AVE
MORENO VALLEY CA
92553-5504
US

IV. Provider business mailing address

23990 EUCALYPTUS AVE
MORENO VALLEY CA
92553-5504
US

V. Phone/Fax

Practice location:
  • Phone: 951-571-4689
  • Fax:
Mailing address:
  • Phone: 951-571-4689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number136692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: