Provider Demographics
NPI:1952563421
Name:NAVARRO, VANESSA MARIA (MD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIA
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2956
Mailing Address - Country:US
Mailing Address - Phone:619-662-4100
Mailing Address - Fax:619-259-2806
Practice Address - Street 1:2400 E 8TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2956
Practice Address - Country:US
Practice Address - Phone:619-662-4100
Practice Address - Fax:619-259-2806
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine