Healthcare Provider Details

I. General information

NPI: 1063954840
Provider Name (Legal Business Name): OLIVIA NOVOA CMPPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 MYERS ST
RIVERSIDE CA
92503-5525
US

IV. Provider business mailing address

3075 MYERS ST
RIVERSIDE CA
92503-5525
US

V. Phone/Fax

Practice location:
  • Phone: 951-271-0188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-IPZHGW
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: