Provider Demographics
NPI:1578705695
Name:NAVARRO, CARMEN (LAC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17250 W SUNSET BLVD
Mailing Address - Street 2:APT 310
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3016
Mailing Address - Country:US
Mailing Address - Phone:310-745-9518
Mailing Address - Fax:
Practice Address - Street 1:1333 OCEAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1023
Practice Address - Country:US
Practice Address - Phone:310-745-9518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12892171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist