Provider Demographics
NPI:1609136670
Name:NAVARRO RIVERA, CECILLE POLICARPIO (ABOC)
Entity type:Individual
Prefix:
First Name:CECILLE
Middle Name:POLICARPIO
Last Name:NAVARRO RIVERA
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 VAN NUYS BLVD UNIT E
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3760
Mailing Address - Country:US
Mailing Address - Phone:661-965-2551
Mailing Address - Fax:
Practice Address - Street 1:8340 VAN NUYS BLVD. UNIT E
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402
Practice Address - Country:US
Practice Address - Phone:661-965-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA161614156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician