Healthcare Provider Details

I. General information

NPI: 1306459755
Provider Name (Legal Business Name): JESUS NAVARRETE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NAPA VALLEJO HWY BLDG 253M1M2
NAPA CA
94558-6234
US

IV. Provider business mailing address

2307 BARRY ST
NAPA CA
94559-4637
US

V. Phone/Fax

Practice location:
  • Phone: 707-255-8001
  • Fax:
Mailing address:
  • Phone: 707-690-2577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberF3155768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: