Provider Demographics
NPI:1558181776
Name:NAVARRO, VIVIAN (RD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 OLD TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4146
Mailing Address - Country:US
Mailing Address - Phone:619-373-3431
Mailing Address - Fax:
Practice Address - Street 1:516 OLD TRAIL DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4146
Practice Address - Country:US
Practice Address - Phone:619-373-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86106454133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered