Provider Demographics
NPI:1083691802
Name:NAVARRO, ROSA M (MD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 FENTON ST
Mailing Address - Street 2:SUITE C101
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3599
Mailing Address - Country:US
Mailing Address - Phone:619-600-5309
Mailing Address - Fax:619-655-4700
Practice Address - Street 1:2452 FENTON ST
Practice Address - Street 2:SUITE C101
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3599
Practice Address - Country:US
Practice Address - Phone:619-600-5309
Practice Address - Fax:619-655-4700
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055554A208VP0014X
CAC53858208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200378570Medicaid
CA1083691802Medicaid
INH01292Medicare UPIN
CADM146ZMedicare PIN
IN236080WMedicare ID - Type Unspecified