Provider Demographics
NPI:1063193563
Name:NAVARRO-GALLARDO, CHRISTIAN HUMBERTO
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:HUMBERTO
Last Name:NAVARRO-GALLARDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N PARK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-3622
Mailing Address - Country:US
Mailing Address - Phone:626-766-8934
Mailing Address - Fax:
Practice Address - Street 1:675 N PARK AVE STE B
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3622
Practice Address - Country:US
Practice Address - Phone:626-766-8934
Practice Address - Fax:909-620-0802
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92933225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist