Provider Demographics
NPI:1740067347
Name:NAVARRO, MARIO RAUL JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:RAUL
Last Name:NAVARRO
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1444 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-1717
Mailing Address - Country:US
Mailing Address - Phone:949-866-3600
Mailing Address - Fax:
Practice Address - Street 1:1444 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-1717
Practice Address - Country:US
Practice Address - Phone:949-866-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant