Provider Demographics
NPI:1689355208
Name:NAVA, JESUS
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:NAVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19119 QUEBEC AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3821
Mailing Address - Country:US
Mailing Address - Phone:951-310-9379
Mailing Address - Fax:
Practice Address - Street 1:19119 QUEBEC AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3821
Practice Address - Country:US
Practice Address - Phone:951-310-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician