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General NPI Number Information
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NPI Number | 1063609634
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Entity Type | Organization
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Legal Business Name | P. RENE NAVARRO, MD, PA
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 11/20/2009
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Provider Practice Location Address
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Address Line | 1137 DRUID CIR
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City | LAKE WALES
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State | FL
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Zip | 33853-4339
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Country | US
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Telephone | 863-676-0702
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Fax | 863-676-2305
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Provider Business Mailing Address
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Address Line | 1137 DRUID CIR
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City | LAKE WALES
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State | FL
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Zip | 33853-4339
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Country | US
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Telephone | 863-676-0702
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Fax | 863-676-2305
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Authorized Official
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Title or Position | OWNER
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Name | DR. RENE NAVARRO
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Credential | MD
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Telephone | 863-676-0702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME28167
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License Number State | FL
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