=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043359219
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUIS J NAVAZO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2007
-----------------------------------------------------
Last Update Date | 02/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3230 WARING CT STE Q
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92056-4509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-591-9975
-----------------------------------------------------
Fax | 760-591-9976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3230 WARING CT STE Q
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92056-4509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-591-9975
-----------------------------------------------------
Fax | 760-591-9976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RM2200X
-----------------------------------------------------
Taxonomy Name | Medical Laboratory Technician
-----------------------------------------------------
License Number | CLM322377
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 247100000X
-----------------------------------------------------
Taxonomy Name | Radiologic Technologist
-----------------------------------------------------
License Number | RHC138799
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | G72940
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------