Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 9149 | CA |
NPI | 1386920114 |
---|---|
Provider Name | Mario Navarro |
First Address | Rialto, CA 92376-5230 |
Second Address | Rialto, CA 92376-5230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2011 |
Last Update Date | 25/10/2011 |