Provider Demographics
NPI:1811562788
Name:NAVA, DANIELA JACKELIN
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:JACKELIN
Last Name:NAVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 WHISPERING WOOD LN
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-9446
Mailing Address - Country:US
Mailing Address - Phone:951-796-2851
Mailing Address - Fax:
Practice Address - Street 1:2601 MARBER AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1137
Practice Address - Country:US
Practice Address - Phone:562-377-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician