Healthcare Provider Details

I. General information

NPI: 1932631215
Provider Name (Legal Business Name): JOSE R NAVARRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 ENTERPRISE RD
ORANGE CITY FL
32763
US

IV. Provider business mailing address

23 CALLE DR NELSON PEREA
MAYAGUEZ PR
00680-4946
US

V. Phone/Fax

Practice location:
  • Phone: 386-775-9575
  • Fax:
Mailing address:
  • Phone: 787-519-1410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN23253
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: