Healthcare Provider Details

I. General information

NPI: 1659340602
Provider Name (Legal Business Name): ROBERT NAVARRETTE JR. CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 S TELSHOR BLVD
LAS CRUCES NM
88011-5049
US

IV. Provider business mailing address

2525 S TELSHOR BLVD STE 102
LAS CRUCES NM
88011-9148
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-5353
  • Fax: 575-522-7571
Mailing address:
  • Phone: 575-522-5353
  • Fax: 575-522-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR41469
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: