Healthcare Provider Details

I. General information

NPI: 1659324101
Provider Name (Legal Business Name): HELENE NOVESTERAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N BESSIE AVE STE 106
TRACY CA
95376
US

IV. Provider business mailing address

1530 N BESSIE AVE STE 106
TRACY CA
95376
US

V. Phone/Fax

Practice location:
  • Phone: 209-833-3386
  • Fax: 209-835-9440
Mailing address:
  • Phone: 209-833-3386
  • Fax: 209-835-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA051250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: