Provider Demographics
NPI:1063561967
Name:NAVAS, RICARDO (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:NAVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 W 3RD ST STE 235E
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-652-4411
Mailing Address - Fax:310-652-2735
Practice Address - Street 1:8631 W 3RD ST STE 235E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-652-4411
Practice Address - Fax:310-652-2735
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38885174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A388850Medicaid
CAWA38885CMedicare PIN
CAA85202Medicare UPIN
CAWA38885FMedicare PIN
CAWA38885DMedicare PIN
CA00A388850Medicaid
CAWA38885AMedicare ID - Type Unspecified