=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609691740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAVARRO'S HEALTH & WELLNESS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2024
-----------------------------------------------------
Last Update Date | 10/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6239 26TH ST
-----------------------------------------------------
City | BERWYN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60402-5150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-380-1733
-----------------------------------------------------
Fax | 833-605-4260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1126
-----------------------------------------------------
City | NORTH RIVERSIDE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60546-0526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-380-1733
-----------------------------------------------------
Fax | 833-605-4260
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | LORENA NAVARRETE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-470-6932
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------