Provider Demographics
NPI:1598419376
Name:NAVARRO, LEEANNA NOELIA MONIQUE (N/A)
Entity Type:Individual
Prefix:
First Name:LEEANNA
Middle Name:NOELIA MONIQUE
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:NAVARRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85225 AVENUE 52 # B
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-2504
Mailing Address - Country:US
Mailing Address - Phone:760-799-6284
Mailing Address - Fax:
Practice Address - Street 1:85225 AVENUE 52 # B
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-2504
Practice Address - Country:US
Practice Address - Phone:760-799-6284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child