Provider Demographics
NPI:1093368839
Name:NAVARRO, EDDIE (RN)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11442 REMSEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3230
Mailing Address - Country:US
Mailing Address - Phone:210-708-5932
Mailing Address - Fax:
Practice Address - Street 1:8700 CROWNHILL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1128
Practice Address - Country:US
Practice Address - Phone:210-824-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX887661163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16300000XMedicaid