Provider Demographics
NPI:1588968754
Name:NAVEEN MISHRA, D.O., P.C.
Entity type:Organization
Organization Name:NAVEEN MISHRA, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHRA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-771-3717
Mailing Address - Street 1:2267 LAVA RIDGE CT STE 125
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4275
Mailing Address - Country:US
Mailing Address - Phone:916-771-3717
Mailing Address - Fax:916-771-3727
Practice Address - Street 1:2267 LAVA RIDGE CT STE 125
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4275
Practice Address - Country:US
Practice Address - Phone:916-771-3717
Practice Address - Fax:916-771-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A109582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty