Healthcare Provider Details

I. General information

NPI: 1407772288
Provider Name (Legal Business Name): MARISA NAVARRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 7TH AVE STE 150
SANTA CRUZ CA
95062-4669
US

IV. Provider business mailing address

200 7TH AVE STE 150
SANTA CRUZ CA
95062-4669
US

V. Phone/Fax

Practice location:
  • Phone: 831-462-1060
  • Fax:
Mailing address:
  • Phone: 831-462-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number26-1770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: