Provider Demographics
NPI:1386833812
Name:NARVARTE, VENUS BASTO (ADMINISTRATOR)
Entity Type:Individual
Prefix:MRS
First Name:VENUS
Middle Name:BASTO
Last Name:NARVARTE
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 WINDHAM CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1137
Mailing Address - Country:US
Mailing Address - Phone:209-608-2688
Mailing Address - Fax:
Practice Address - Street 1:3510 WINDHAM CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1137
Practice Address - Country:US
Practice Address - Phone:209-608-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities