Provider Demographics
NPI:1619078599
Name:ITCHON, LIDEIA NAVASCA (MD)
Entity Type:Individual
Prefix:DR
First Name:LIDEIA
Middle Name:NAVASCA
Last Name:ITCHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25835 NARBONNE AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-3085
Mailing Address - Country:US
Mailing Address - Phone:310-517-0977
Mailing Address - Fax:310-517-9811
Practice Address - Street 1:25835 NARBONNE AVE STE 260
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3085
Practice Address - Country:US
Practice Address - Phone:310-517-0977
Practice Address - Fax:310-517-9811
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67003208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics