Provider Demographics
NPI:1043359219
Name:NAVAZO, LUIS J (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:J
Last Name:NAVAZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 WARING CT STE Q
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4509
Mailing Address - Country:US
Mailing Address - Phone:760-591-9975
Mailing Address - Fax:760-591-9976
Practice Address - Street 1:3230 WARING CT STE Q
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4509
Practice Address - Country:US
Practice Address - Phone:760-591-9975
Practice Address - Fax:760-591-9976
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLM322377246RM2200X
CARHC138799247100000X
CAG72940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA1118OtherRAILROAD MEDICARE
CA00G729400Medicaid
CA00G729400OtherBCBS
CA460495608OtherTRICARE
CAF18641Medicare UPIN