Provider Demographics
NPI:1053144097
Name:NAVARRA, MARIA TERESA TANTOCO
Entity type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:TANTOCO
Last Name:NAVARRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 INCLINADO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3249
Mailing Address - Country:US
Mailing Address - Phone:949-212-7045
Mailing Address - Fax:
Practice Address - Street 1:3120 INCLINADO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-3249
Practice Address - Country:US
Practice Address - Phone:949-212-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility