Provider Demographics
NPI:1639285323
Name:NAVA, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:NAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 N 32ND ST
Mailing Address - Street 2:STE 104
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3357
Mailing Address - Country:US
Mailing Address - Phone:602-279-6282
Mailing Address - Fax:602-274-2157
Practice Address - Street 1:4530 N 32ND ST
Practice Address - Street 2:STE 104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3357
Practice Address - Country:US
Practice Address - Phone:602-279-6282
Practice Address - Fax:602-274-2157
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00230446OtherRAILROAD MEDICARE
AZ374710Medicaid
AZAZ0752990OtherBCBS PIN
AZ2Z0735OtherHEALTHNET PIN
AZAZ0752990OtherBCBS PIN
AZ76889Medicare ID - Type Unspecified