Healthcare Provider Details

I. General information

NPI: 1326797358
Provider Name (Legal Business Name): MISTY NAVARRETE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6926 BROCKTON AVE STE 6
RIVERSIDE CA
92506-3804
US

IV. Provider business mailing address

MISTALNAVA@MSN.COM 1027 MARIGOLD COURT
CALIMESA CA
92320
US

V. Phone/Fax

Practice location:
  • Phone: 951-779-1670
  • Fax:
Mailing address:
  • Phone: 909-991-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95019838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: