Provider Demographics
NPI:1548538234
Name:NAVARRETE, MAYRA (LVN)
Entity type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:
Last Name:NAVARRETE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8071 7TH ST
Mailing Address - Street 2:APT 12
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8071 7TH ST
Practice Address - Street 2:APT 12
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3056
Practice Address - Country:US
Practice Address - Phone:714-496-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN258863164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101307Medicare UPIN