Provider Demographics
NPI:1447553607
Name:NAVA, MAURO S (RT)
Entity type:Individual
Prefix:MR
First Name:MAURO
Middle Name:S
Last Name:NAVA
Suffix:
Gender:M
Credentials:RT
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Mailing Address - Street 1:1804 JUNE ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3146
Mailing Address - Country:US
Mailing Address - Phone:505-843-9836
Mailing Address - Fax:505-332-9825
Practice Address - Street 1:1804 JUNE ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3146
Practice Address - Country:US
Practice Address - Phone:505-843-9836
Practice Address - Fax:505-332-9825
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM152381247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist