Provider Demographics
NPI:1851904031
Name:NAVA MOCTEZUMA, STEPHANIE JACKELINE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JACKELINE
Last Name:NAVA MOCTEZUMA
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 1:7409 CANYON CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-4313
Mailing Address - Country:US
Mailing Address - Phone:661-932-5815
Mailing Address - Fax:
Practice Address - Street 1:1300 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4504
Practice Address - Country:US
Practice Address - Phone:661-854-6590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool