Provider Demographics
NPI:1851064166
Name:NAVA, GERARDO GUILLERMO
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:GUILLERMO
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 1:826 OLD AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4302
Mailing Address - Country:US
Mailing Address - Phone:864-322-3159
Mailing Address - Fax:
Practice Address - Street 1:826 OLD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4302
Practice Address - Country:US
Practice Address - Phone:864-322-3159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12398225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist