Healthcare Provider Details

I. General information

NPI: 1013105535
Provider Name (Legal Business Name): MARIA LUNA TAN NAVARRO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

# 5 ELK SHOPPING PLAZA
ELKVIEW WV
25071
US

IV. Provider business mailing address

PO BOX 193
CHARLESTON WV
25321-0193
US

V. Phone/Fax

Practice location:
  • Phone: 304-965-5888
  • Fax: 304-965-3882
Mailing address:
  • Phone: 304-965-5888
  • Fax: 304-965-3882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAMON NAVARRO
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-965-5888