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General NPI Number Information
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NPI Number | 1972072478
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Entity Type | Individual
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Provider Name | MARY NELLY GERONIMO NAVARRETE DPT
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Gender | Female
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 137 E THOUSAND OAKS BLVD
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5707
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Country | US
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Telephone | 805-379-2132
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Fax | 805-917-4206
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Provider Business Mailing Address
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Address Line | 5720 RALSTON ST STE 200
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City | VENTURA
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State | CA
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Zip | 93003-7844
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Country | US
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Telephone | 805-804-4168
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Fax | 805-830-1177
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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 | 295962
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License Number State | CA
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