Individual provider Active NPI

Benjamin Navarro, M.D.

  • Internal Medicine Physician
  • Garden Grove, CA
National Provider Identifier
1033208608
Registry record updated Nov 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A39177 Issued in CA
Practice address
12751 Harbor Blvd
Garden Grove, CA 92840-5800
Phone
(714) 636-7852
Fax
(714) 636-0928
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A39177 CA Primary

Addresses

Primary practice location

12751 Harbor Blvd
Garden Grove, CA 92840-5800

Mailing address

12751 Harbor Blvd
Garden Grove, CA 92840-5800
Phone (714) 636-7852

Other identifiers 1

IdentifierTypeStateIssuer
00A391770MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A39177CAMDInternal Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321488000000",
    "number": "1033208608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12751 HARBOR BLVD",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928405800",
            "telephone_number": "714-636-7852",
            "fax_number": "714-636-0928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12751 HARBOR BLVD",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928405800",
            "telephone_number": "714-636-7852",
            "fax_number": "714-636-0928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAVARRO",
        "first_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2011-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A39177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A391770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.