Provider Demographics
NPI:1679314231
Name:NAVUSO, VINAISI
Entity type:Individual
Prefix:
First Name:VINAISI
Middle Name:
Last Name:NAVUSO
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 1:199 GREENFIELD AVE RM 10
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2670
Mailing Address - Country:US
Mailing Address - Phone:408-775-3723
Mailing Address - Fax:
Practice Address - Street 1:199 GREENFIELD AVE RM 10
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2670
Practice Address - Country:US
Practice Address - Phone:408-775-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2147000372278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health