Healthcare Provider Details

I. General information

NPI: 1164352415
Provider Name (Legal Business Name): MIGUEL NAVA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 E HOSPITALITY LN STE 400
SAN BERNARDINO CA
92408-3545
US

IV. Provider business mailing address

2036 E 17TH ST
SAN BERNARDINO CA
92404-5802
US

V. Phone/Fax

Practice location:
  • Phone: 909-513-5772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number106E00000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: