Provider Demographics
NPI:1730537374
Name:NAVARRO, DEZERI (PA-C, MMS)
Entity type:Individual
Prefix:
First Name:DEZERI
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:PA-C, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 N ROXBURY DR STE 212
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5017
Mailing Address - Country:US
Mailing Address - Phone:310-273-0467
Mailing Address - Fax:310-273-2382
Practice Address - Street 1:436 N ROXBURY DR STE 212
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5017
Practice Address - Country:US
Practice Address - Phone:310-273-0467
Practice Address - Fax:310-273-2382
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant