Provider Demographics
NPI:1184255663
Name:NAVA, MAYRA
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:NAVA
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 1:9987 WALLACE WAY
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9252
Mailing Address - Country:US
Mailing Address - Phone:707-548-9106
Mailing Address - Fax:
Practice Address - Street 1:9987 WALLACE WAY
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-9252
Practice Address - Country:US
Practice Address - Phone:707-548-9106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62195126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant