Basic Information
| Provider Information | |||||||||
| NPI: | 1205086576 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAVA | ||||||||
| FirstName: | EDGAR | ||||||||
| MiddleName: | RESENDIZ | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1885 LUNDY AVE STE 223 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951311888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082849010 | ||||||||
| FaxNumber: | 4082849048 | ||||||||
| Practice Location | |||||||||
| Address1: | 1885 LUNDY AVE STE 223 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951311888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082849010 | ||||||||
| FaxNumber: | 4082849048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2008 | ||||||||
| LastUpdateDate: | 09/24/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.