MEDICARE: MARIA GUADALUPE NAVARRO ELIAS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA17084	TX

General Provider Information

NPI Number	:	1518745066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA GUADALUPE NAVARRO ELIAS PA-C

Provider Business Mailing Address
First Line	:	406 INDUSTRIAL PARK LN
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-3039
Country	:	US
Telephone Number	:	936-520-2969
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 ALPINE ST
Second Line	:
City	:	COLDSPRING
State	:	TX
Zip	:	77331-8058
Country	:	US
Telephone Number	:	936-647-2227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	09/18/2023

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