Healthcare Provider Details

I. General information

NPI: 1053578690
Provider Name (Legal Business Name): MARIA ZITA NARVAEZ D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303A ANASTASIA BLVD
ST AUGUSTINE FL
32080-4506
US

IV. Provider business mailing address

303A ANASTASIA BLVD
ST AUGUSTINE FL
32080-4506
US

V. Phone/Fax

Practice location:
  • Phone: 904-810-2320
  • Fax:
Mailing address:
  • Phone: 904-810-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13476
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: