Healthcare Provider Details

I. General information

NPI: 1295942092
Provider Name (Legal Business Name): JERRY NAVARRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 SUTTERVILLE RD
SACRAMENTO CA
95820-1024
US

IV. Provider business mailing address

2608 LUNAR LN
SACRAMENTO CA
95864-7750
US

V. Phone/Fax

Practice location:
  • Phone: 916-732-2250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: