Healthcare Provider Details

I. General information

NPI: 1780155630
Provider Name (Legal Business Name): FOREST NOVAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13585 SAN PABLO AVE
SAN PABLO CA
94806-3863
US

IV. Provider business mailing address

13585 SAN PABLO AVE
SAN PABLO CA
94806-3863
US

V. Phone/Fax

Practice location:
  • Phone: 510-942-4700
  • Fax:
Mailing address:
  • Phone: 510-942-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number140924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: