Healthcare Provider Details

I. General information

NPI: 1578029856
Provider Name (Legal Business Name): ELIZABETH NOVOA-PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N. PCH HWY SUITE 1400
EL SEGUNDO CA
90245
US

IV. Provider business mailing address

100 N. PCH HWY SUITE 1400
EL SEGUNDO CA
90245
US

V. Phone/Fax

Practice location:
  • Phone: 310-856-0800
  • Fax:
Mailing address:
  • Phone: 310-856-0800
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: