Healthcare Provider Details

I. General information

NPI: 1255776316
Provider Name (Legal Business Name): EDNA NAVARRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14317 NW BLVD SUITE A
CORPUS CHRISTI TX
78410-5536
US

IV. Provider business mailing address

14317 NW BLVD SUITE A
CORPUS CHRISTI TX
78410-5536
US

V. Phone/Fax

Practice location:
  • Phone: 361-241-0324
  • Fax: 361-387-4153
Mailing address:
  • Phone: 361-241-0324
  • Fax: 361-387-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number89380
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: