Provider Demographics
NPI:1699549196
Name:NAVARRO, ORQUIDEA
Entity type:Individual
Prefix:
First Name:ORQUIDEA
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 WESTOVER AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1538
Mailing Address - Country:US
Mailing Address - Phone:773-571-0315
Mailing Address - Fax:833-605-4260
Practice Address - Street 1:5533 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2236
Practice Address - Country:US
Practice Address - Phone:312-380-1733
Practice Address - Fax:833-605-4260
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2023168360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty