Provider Demographics
NPI:1639227044
Name:NAVA, VICTOR MANUEL (MD)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:MANUEL
Last Name:NAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 EXPOSITION BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-5196
Mailing Address - Country:US
Mailing Address - Phone:916-297-6257
Mailing Address - Fax:
Practice Address - Street 1:1565 EXPOSITION BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-5196
Practice Address - Country:US
Practice Address - Phone:916-297-6257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50719208200000X, 207R00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C507190OtherBLUE SHIELD
CA00C507190OtherBLUE SHIELD