Provider Demographics
NPI:1336247733
Name:MISHRA, NAVEEN (DO)
Entity Type:Individual
Prefix:
First Name:NAVEEN
Middle Name:
Last Name:MISHRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2267 LAVA RIDGE CT STE 125
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4275
Mailing Address - Country:US
Mailing Address - Phone:916-771-3717
Mailing Address - Fax:916-771-3727
Practice Address - Street 1:2267 LAVA RIDGE CT STE 125
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4275
Practice Address - Country:US
Practice Address - Phone:916-771-3717
Practice Address - Fax:916-771-3727
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDO261382084P0800X
CA20A109582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry