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NPI Code Detail

MEDICARE: KRYSTL ARMEN NOVAK MS, OTRL

MEDICARE: KRYSTL ARMEN NOVAK MS, OTRL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational TherapistOT2228CA

General Provider Information

NPI Number : 1134241722
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTL ARMEN NOVAK MS, OTRL
Provider Business Mailing Address
First Line : 6780 MISSION GORGE RD
Second Line : UNIT 31
City : SAN DIEGO
State : CA
Zip : 92120-2400
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1609 E MADISON AVE
Second Line :
City : EL CAJON
State : CA
Zip : 92019-1046
Country : US
Telephone Number : 619-588-3166
Fax Number : 619-579-4882
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 07/08/2007

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