Provider Demographics
NPI:1922290030
Name:NAVARRO, REIKO T (NP)
Entity Type:Individual
Prefix:MS
First Name:REIKO
Middle Name:T
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WEST CARSON STREET
Mailing Address - Street 2:BOX 483 HARBOR UCLA
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90509-2910
Mailing Address - Country:US
Mailing Address - Phone:310-222-2006
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:BOX 483
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504708363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health