Healthcare Provider Details

I. General information

NPI: 1306826847
Provider Name (Legal Business Name): JOSH NOVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 SOQUEL DR #D
SANTA CRUZ CA
95065-1709
US

IV. Provider business mailing address

2025 SOQUEL AVE
SANTA CRUZ CA
95062-1323
US

V. Phone/Fax

Practice location:
  • Phone: 831-460-6041
  • Fax: 831-476-7708
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG62866
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: