Healthcare Provider Details

I. General information

NPI: 1427121896
Provider Name (Legal Business Name): PETER NAVOLANIC II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 GEORGIA ST SUITE B
VALLEJO CA
94590-5905
US

IV. Provider business mailing address

PO BOX 22210
OAKLAND CA
94623-2210
US

V. Phone/Fax

Practice location:
  • Phone: 707-556-8100
  • Fax: 707-556-8107
Mailing address:
  • Phone: 510-535-3655
  • Fax: 510-535-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberGO25971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: