Healthcare Provider Details

I. General information

NPI: 1366196578
Provider Name (Legal Business Name): MIGUEL NAVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9148 PARKBURY LN
LEWIS CENTER OH
43035-9548
US

IV. Provider business mailing address

9148 PARKBURY LN
LEWIS CENTER OH
43035-9548
US

V. Phone/Fax

Practice location:
  • Phone: 614-674-7303
  • Fax:
Mailing address:
  • Phone: 614-674-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: