Healthcare Provider Details

I. General information

NPI: 1053843862
Provider Name (Legal Business Name): VINCENT REGINALD FAVOR NARVAEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 10/10/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 MAGNOLIA AVE
RIVERSIDE CA
92504-3849
US

IV. Provider business mailing address

5880 LOCHMOOR DR
RIVERSIDE CA
92507-8506
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0626
  • Fax:
Mailing address:
  • Phone: 562-343-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA184000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: