Provider Demographics
NPI:1770555435
Name:MARITZA NAVARRO MD PA
Entity type:Organization
Organization Name:MARITZA NAVARRO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-892-3336
Mailing Address - Street 1:1900 SCOFIELD RIDGE PKWY
Mailing Address - Street 2:#6203
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-1600
Mailing Address - Country:US
Mailing Address - Phone:512-892-3336
Mailing Address - Fax:512-892-3338
Practice Address - Street 1:12414 ALDERBROOK DR
Practice Address - Street 2:#201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2480
Practice Address - Country:US
Practice Address - Phone:512-892-3336
Practice Address - Fax:512-892-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0953207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30MUOtherBCBS OF TEXAS GROUP #
TX30MUOtherBCBS OF TEXAS GROUP #