Healthcare Provider Details

I. General information

NPI: 1942485313
Provider Name (Legal Business Name): FELICIANO NAVALTA JR., M.D. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16660 PARAMOUNT BLVD SUITE 306
PARAMOUNT CA
90723-5433
US

IV. Provider business mailing address

16660 PARAMOUNT BLVD SUITE 306
PARAMOUNT CA
90723-5433
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-1404
  • Fax: 562-633-3036
Mailing address:
  • Phone: 562-633-1404
  • Fax: 562-633-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA25135
License Number StateCA

VIII. Authorized Official

Name: DR. FELICIANO SISON NAVALTA JR.
Title or Position: PHYSICAN
Credential: M.D.
Phone: 562-633-1404