Provider Demographics
NPI:1114277431
Name:NAVARRO, MARLON DE LUNA
Entity Type:Individual
Prefix:MR
First Name:MARLON
Middle Name:DE LUNA
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 CALBEG
Mailing Address - Street 2:
Mailing Address - City:MALASIQUI
Mailing Address - State:PANGASINAN
Mailing Address - Zip Code:2421
Mailing Address - Country:PH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1022 LINCOLN AVENUE
Practice Address - Street 2:APT. 4
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068
Practice Address - Country:US
Practice Address - Phone:954-512-4194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist