Healthcare Provider Details

I. General information

NPI: 1003934571
Provider Name (Legal Business Name): YOLANDA CAROLINA NOVELO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CABRILLO HWY S SUITE 200A
HALF MOON BAY CA
94019-8200
US

IV. Provider business mailing address

1510 FASHION ISLAND BLVD STE 310
SAN MATEO CA
94404-1587
US

V. Phone/Fax

Practice location:
  • Phone: 650-372-3238
  • Fax: 650-786-4963
Mailing address:
  • Phone: 628-777-6226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: