Provider Demographics
NPI:1619159456
Name:NAVAREZ, RICHARD J JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:NAVAREZ
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:220 FALCON PKWY
Mailing Address - Street 2:21MEDICAL SQ
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80912-5005
Mailing Address - Country:US
Mailing Address - Phone:719-567-5067
Mailing Address - Fax:
Practice Address - Street 1:220 FALCON PKWY
Practice Address - Street 2:21 MEDICAL SQ
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80912-5005
Practice Address - Country:US
Practice Address - Phone:719-567-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1080515363A00000X
COPA.0005340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant