Provider Demographics
NPI:1659340602
Name:NAVARRETTE, ROBERT JR (CNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:NAVARRETTE
Suffix:JR
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S TELSHOR BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-9148
Mailing Address - Country:US
Mailing Address - Phone:575-522-5353
Mailing Address - Fax:575-522-7571
Practice Address - Street 1:2405 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5049
Practice Address - Country:US
Practice Address - Phone:575-522-5353
Practice Address - Fax:575-522-7571
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR41469363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59471387Medicaid
NM59471387Medicaid
348402601Medicare PIN