Healthcare Provider Details

I. General information

NPI: 1669886255
Provider Name (Legal Business Name): KATRINA ANNE NAVARRO L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 232ND ST SW
MOUNTLAKE TERRACE WA
98043-4939
US

IV. Provider business mailing address

4401 232ND ST SW
MOUNTLAKE TERRACE WA
98043-4939
US

V. Phone/Fax

Practice location:
  • Phone: 206-962-1669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number603395904
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: