Healthcare Provider Details

I. General information

NPI: 1962281683
Provider Name (Legal Business Name): RAUL NAVARRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E SAN JACINTO AVE
PERRIS CA
92570-2878
US

IV. Provider business mailing address

308 E SAN JACINTO AVE
PERRIS CA
92570-2878
US

V. Phone/Fax

Practice location:
  • Phone: 951-217-6880
  • Fax:
Mailing address:
  • Phone: 951-217-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-TZOGKW
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: