Provider Demographics
NPI:1326797358
Name:NAVARRETE, MISTY
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:NAVARRETE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MISTALNAVA@MSN.COM
Mailing Address - Street 2:1027 MARIGOLD COURT
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320
Mailing Address - Country:US
Mailing Address - Phone:909-991-5001
Mailing Address - Fax:
Practice Address - Street 1:6926 BROCKTON AVE STE 6
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3804
Practice Address - Country:US
Practice Address - Phone:951-779-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95019838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily