Provider Demographics
NPI:1821551763
Name:NAVARRETE, RICARDO JR (DPM)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:NAVARRETE
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3989 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2001
Mailing Address - Country:US
Mailing Address - Phone:619-283-2097
Mailing Address - Fax:619-860-1289
Practice Address - Street 1:3989 32ND ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2001
Practice Address - Country:US
Practice Address - Phone:619-283-2097
Practice Address - Fax:619-860-1289
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5995213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty