Provider Demographics
NPI:1356992614
Name:NAVARRO, MARK JOSEPH (FNP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12595 HESPERIA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5882
Mailing Address - Country:US
Mailing Address - Phone:760-881-3377
Mailing Address - Fax:760-881-3379
Practice Address - Street 1:12595 HESPERIA RD STE 101
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5882
Practice Address - Country:US
Practice Address - Phone:760-881-3377
Practice Address - Fax:760-881-3379
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily