Healthcare Provider Details

I. General information

NPI: 1396325213
Provider Name (Legal Business Name): JUAN PABLO NAVARRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3399 STRAUSS AVE STE 219
INDIAN HEAD MD
20640-5164
US

IV. Provider business mailing address

7900 PURITAN CT NE
ALBUQUERQUE NM
87109-5179
US

V. Phone/Fax

Practice location:
  • Phone: 575-693-2509
  • Fax:
Mailing address:
  • Phone: 575-693-2509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101283201
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: