Healthcare Provider Details

I. General information

NPI: 1457978967
Provider Name (Legal Business Name): NOVELLUS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 N ORO VIS
LITCHFIELD PARK AZ
85340-4548
US

IV. Provider business mailing address

5115 N DYSART RD STE 202 UNIT 193
LITCHFIELD PARK AZ
85340-3036
US

V. Phone/Fax

Practice location:
  • Phone: 602-888-2344
  • Fax: 480-712-1305
Mailing address:
  • Phone: 602-510-8627
  • Fax: 480-712-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL KESSLER
Title or Position: OWNER
Credential:
Phone: 602-888-2344