Provider Demographics
NPI:1871017400
Name:NAVALTA, JULIA VIVIEN DE JESUS (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JULIA VIVIEN
Middle Name:DE JESUS
Last Name:NAVALTA
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:JULIA VIVIEN
Other - Middle Name:ROXAS
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:6170 N DURANGO DR STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3923
Practice Address - Country:US
Practice Address - Phone:702-940-1550
Practice Address - Fax:702-940-1551
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPRN002556OtherSTATE LICENSE
NV1871017400Medicaid