Individual provider Active NPI

Juan Manuel Navarro Jr., PSY.D.

  • Clinical Psychologist
  • View Park, CA
National Provider Identifier
1912268657
Registry record updated May 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY29204 Issued in CA
Practice address
3741 Stocker St
View Park, CA 90008-5109
Phone
(323) 290-5812
NPI assigned
May 30, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY29204 CA Primary

Addresses

Primary practice location

3741 Stocker St
View Park, CA 90008-5109

Mailing address

850 E Foothill Blvd
Rialto, CA 92376-5230

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190812001394 CA Practitioner - Clinical Psychologist 0749517969 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY29204CAMDClinical Psychologist
29204CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mission City Community Network, Inc. Current Accepting new patients
Mission City Community Network, Inc. CurrentSince Jun 15, 2022 Accepting new patients
Mission City Community Network, Inc. CurrentSince Jun 15, 2022 Accepting new patients
Serene Health Past Accepting new patients

Locations

15206 Parthenia St
Sepulveda, CA 91343

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1338336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496016000000",
    "number": "1912268657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 E FOOTHILL BLVD",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923765230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3741 STOCKER ST",
            "city": "VIEW PARK",
            "state": "CA",
            "postal_code": "900085109",
            "telephone_number": "323-290-5812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAVARRO",
        "first_name": "JUAN",
        "middle_name": "MANUEL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-30",
        "last_updated": "2017-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY29204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in View Park, CA

Sources for this page

Verify at the official NPI Registry.