Healthcare Provider Details

I. General information

NPI: 1497486310
Provider Name (Legal Business Name): CARLOS ENRIQUE NAVARRETE TORRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR STE 304
SAN DIEGO CA
92134-1304
US

IV. Provider business mailing address

34800 BOB WILSON DR STE 304
SAN DIEGO CA
92134-1304
US

V. Phone/Fax

Practice location:
  • Phone: 936-689-2063
  • Fax:
Mailing address:
  • Phone: 936-689-2063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number1497486310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: