Healthcare Provider Details

I. General information

NPI: 1740576511
Provider Name (Legal Business Name): MARIA BERENICE NAVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 VIEWRIDGE AVE
SAN DIEGO CA
92123-1637
US

IV. Provider business mailing address

4510 VIEWRIDGE AVE
SAN DIEGO CA
92123-1637
US

V. Phone/Fax

Practice location:
  • Phone: 562-618-3763
  • Fax:
Mailing address:
  • Phone: 877-236-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA142216
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number390200000
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: