Provider Demographics
NPI:1316993561
Name:NAVALEZA, JOSELITO SAN ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:JOSELITO
Middle Name:SAN ANTONIO
Last Name:NAVALEZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8420 OCEAN GTWY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7169
Mailing Address - Country:US
Mailing Address - Phone:410-822-0424
Mailing Address - Fax:410-822-2283
Practice Address - Street 1:8420 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7169
Practice Address - Country:US
Practice Address - Phone:410-822-0424
Practice Address - Fax:410-822-2283
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064417207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0064417OtherMEDICAL LICENSE
MD0101487600Medicaid
MDS719O056OtherMEDICARE
MD0101487600Medicaid