Provider Demographics
NPI:1265727762
Name:NAVARRO PAIN CONTROL GROUP INC.
Entity type:Organization
Organization Name:NAVARRO PAIN CONTROL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-600-5309
Mailing Address - Street 1:2452 FENTON STREET
Mailing Address - Street 2:C101
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4543
Mailing Address - Country:US
Mailing Address - Phone:619-600-5309
Mailing Address - Fax:619-655-4700
Practice Address - Street 1:2452 FENTON STREET
Practice Address - Street 2:C101
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4543
Practice Address - Country:US
Practice Address - Phone:619-600-5309
Practice Address - Fax:619-655-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53858208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265727762 IN PROCESMedicaid
CA1265727762 IN PROCESMedicaid