Healthcare Provider Details

I. General information

NPI: 1295351286
Provider Name (Legal Business Name): SARAY NAVARRO SUDRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAY BARRERA SUDRC

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 W VISTA WAY
VISTA CA
92083-6019
US

IV. Provider business mailing address

1939 W VISTA WAY
VISTA CA
92083-6019
US

V. Phone/Fax

Practice location:
  • Phone: 760-305-7528
  • Fax: 760-509-4410
Mailing address:
  • Phone: 760-305-7528
  • Fax: 760-509-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: