Healthcare Provider Details

I. General information

NPI: 1083161947
Provider Name (Legal Business Name): MONA LISA NAVA CSFA, CST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 SHADOW WILLOW DR
EL PASO TX
79922-1866
US

IV. Provider business mailing address

617 SHADOW WILLOW DR
EL PASO TX
79922-1866
US

V. Phone/Fax

Practice location:
  • Phone: 915-587-1090
  • Fax:
Mailing address:
  • Phone: 915-587-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number168129
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number168129
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: