1871768358 NPI number — MR. RIVER QUINN MARTINEZ NAVARRO LMFT

Table of content: MR. RIVER QUINN MARTINEZ NAVARRO LMFT (NPI 1871768358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871768358 NPI number — MR. RIVER QUINN MARTINEZ NAVARRO LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAVARRO
Provider First Name:
RIVER
Provider Middle Name:
QUINN MARTINEZ
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NAVARRO
Provider Other First Name:
TAMMY
Provider Other Middle Name:
DOLORES
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871768358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5201 WHITE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-241-6210
Provider Business Mailing Address Fax Number:
661-241-6254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5201 WHITE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-241-6210
Provider Business Practice Location Address Fax Number:
661-241-6254
Provider Enumeration Date:
04/25/2008

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: 106H00000X , with the licence number:  96344 , 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)





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