Provider Demographics
NPI:1437041217
Name:NAVONE, NISSA MARIE (RADT, AA)
Entity type:Individual
Prefix:
First Name:NISSA
Middle Name:MARIE
Last Name:NAVONE
Suffix:
Gender:F
Credentials:RADT, AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19401 SUSAN WAY
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9266
Mailing Address - Country:US
Mailing Address - Phone:209-694-9705
Mailing Address - Fax:209-396-3345
Practice Address - Street 1:19401 SUSAN WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9266
Practice Address - Country:US
Practice Address - Phone:209-694-9705
Practice Address - Fax:209-396-3345
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care