Provider Demographics
NPI:1982875498
Name:NAVARRO, ALLAN B (IDC)
Entity Type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:B
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:MR
Other - First Name:ALLAN
Other - Middle Name:B
Other - Last Name:NAVARRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IDC
Mailing Address - Street 1:2805 VIA DIEGO
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-8347
Mailing Address - Country:US
Mailing Address - Phone:760-729-5226
Mailing Address - Fax:
Practice Address - Street 1:2805 VIA DIEGO
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-8347
Practice Address - Country:US
Practice Address - Phone:760-729-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman