Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1700166980 |
---|---|
Provider Name | Tia Kamele Emi Navarro |
First Address | North Las Vegas, NV 89031-2334 |
Second Address | North Las Vegas, NV 89031-2334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2011 |
Last Update Date | 10/04/2012 |