Healthcare Provider Details

I. General information

NPI: 1790293538
Provider Name (Legal Business Name): ALEXIA LAUREN NOVAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 01/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 UTICA AVE STE 259
RANCHO CUCAMONGA CA
91730-3852
US

IV. Provider business mailing address

8300 UTICA AVE STE 259
RANCHO CUCAMONGA CA
91730-3852
US

V. Phone/Fax

Practice location:
  • Phone: 909-906-1505
  • Fax: 909-906-1508
Mailing address:
  • Phone: 909-906-1505
  • Fax: 909-906-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: