Provider Demographics
NPI:1083326284
Name:NAVARRO, STEPHANIE (CMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 S FRANCISCO WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-5434
Mailing Address - Country:US
Mailing Address - Phone:925-380-1579
Mailing Address - Fax:
Practice Address - Street 1:3323 S FRANCISCO WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-5434
Practice Address - Country:US
Practice Address - Phone:925-380-1579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89823225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA89823OtherCERTIFIED MASSAGE THERAPIST