Provider Demographics
NPI:1942485313
Name:FELICIANO NAVALTA JR., M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:FELICIANO NAVALTA JR., M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIANO
Authorized Official - Middle Name:SISON
Authorized Official - Last Name:NAVALTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:562-633-1404
Mailing Address - Street 1:16660 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5433
Mailing Address - Country:US
Mailing Address - Phone:562-633-1404
Mailing Address - Fax:562-633-3036
Practice Address - Street 1:16660 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5433
Practice Address - Country:US
Practice Address - Phone:562-633-1404
Practice Address - Fax:562-633-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25135261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A251351Medicaid
CAA25135Medicare PIN
CAA24295Medicare UPIN
CA4154670001Medicare NSC