Provider Demographics
NPI:1972749737
Name:VICTOR M NAVA M D INC
Entity type:Organization
Organization Name:VICTOR M NAVA M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:NAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-481-3045
Mailing Address - Street 1:100 S. HARDING BLVD. #2
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3360
Mailing Address - Country:US
Mailing Address - Phone:916-773-6282
Mailing Address - Fax:916-797-4037
Practice Address - Street 1:100 S. HARDING BLVD. #2
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-3360
Practice Address - Country:US
Practice Address - Phone:916-481-3045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50719174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C507190OtherBLUE SHIELD
CAC82325Medicare UPIN