1679598577 NPI number — EBBA L NAVAS CRNA

Table of content: EBBA L NAVAS CRNA (NPI 1679598577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679598577 NPI number — EBBA L NAVAS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAVAS
Provider First Name:
EBBA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679598577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 PENNSYLVANIA AVE
Provider Second Line Business Mailing Address:
STE 145 NORTHBAY NEONATOLOGY AND ASSOCIATES INC
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94533-3590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-270-0340
Provider Business Mailing Address Fax Number:
888-270-0331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUTTER SOLANO MEDICAL CENTER
Provider Business Practice Location Address City Name:
VALLEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-554-5226
Provider Business Practice Location Address Fax Number:
707-554-5102
Provider Enumeration Date:
07/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN637822 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: NA3116 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 637822 . This is a "RN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3116 . This is a "NA" identifier . This identifiers is of the category "OTHER".