Provider Demographics
NPI:1447326855
Name:NAVARRETE, JOSE CLEMENTE (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:CLEMENTE
Last Name:NAVARRETE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6043 ATLANTIC BLVD.
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-3118
Mailing Address - Country:US
Mailing Address - Phone:323-771-9680
Mailing Address - Fax:323-771-2989
Practice Address - Street 1:6043 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3118
Practice Address - Country:US
Practice Address - Phone:323-771-9680
Practice Address - Fax:323-771-2989
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2013-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA36377208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A363770Medicaid
CAA84878Medicare UPIN