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General NPI Number Information
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NPI Number | 1427695774
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Entity Type | Individual
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Provider Name | INGRID MICHELLE NAVEIRA
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Gender | Female
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 126 CHEESBROUGHS LN
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City | LOS ANGELES
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State | CA
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Zip | 90063-2839
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Country | US
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Telephone | 909-657-6773
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Fax |
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Provider Business Mailing Address
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Address Line | 126 CHEESBROUGHS LN
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City | LOS ANGELES
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State | CA
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Zip | 90063-2839
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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