MEDICARE: RONALD ANTHONY NOVELLI PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA13754	CA

General Provider Information

NPI Number	:	1245631159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD ANTHONY NOVELLI PA

Provider Business Mailing Address
First Line	:	3689 EUREKA WAY
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-0177
Country	:	US
Telephone Number	:	530-244-4577
Fax Number	:

Provider Business Practice Location Address
First Line	:	3689 EUREKA WAY
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-0177
Country	:	US
Telephone Number	:	530-244-4577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	09/10/2014

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