1265727762 NPI number — NAVARRO PAIN CONTROL GROUP INC.

Table of content: (NPI 1265727762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265727762 NPI number — NAVARRO PAIN CONTROL GROUP INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAVARRO PAIN CONTROL GROUP INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1265727762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2452 FENTON STREET
Provider Second Line Business Mailing Address:
C101
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91914-4543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-600-5309
Provider Business Mailing Address Fax Number:
619-655-4700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2452 FENTON STREET
Provider Second Line Business Practice Location Address:
C101
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91914-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-600-5309
Provider Business Practice Location Address Fax Number:
619-655-4700
Provider Enumeration Date:
06/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NAVARRO
Authorized Official First Name:
ROSA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT / OWNER
Authorized Official Telephone Number:
619-600-5309

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  C53858 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1265727762 IN PROCES , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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