Provider Demographics
NPI:1598523235
Name:NAVARRO, JESUS MARQUEZ (ATC)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:MARQUEZ
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 S SISKIYOU AVE
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-9347
Mailing Address - Country:US
Mailing Address - Phone:559-355-0497
Mailing Address - Fax:
Practice Address - Street 1:546 S SISKIYOU AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-9347
Practice Address - Country:US
Practice Address - Phone:559-355-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000512862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer