MEDICARE: DR. JOSE E NOVOA M.D.

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
1	207RC0000X	Cardiovascular Disease Physician	11665	PR

General Provider Information

NPI Number	:	1629079736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE E NOVOA M.D.

Provider Business Mailing Address
First Line	:	66 CALLE SANTA CRUZ
Second Line	:	PLAZA SAN PABLO 1 SUITE 101
City	:	BAYAMON
State	:	PR
Zip	:	00961-7041
Country	:	US
Telephone Number	:	787-786-6115
Fax Number	:	787-740-3088

Provider Business Practice Location Address
First Line	:	66 CALLE SANTA CRUZ
Second Line	:	PLAZA SAN PABLO I SUITE 101
City	:	BAYAMON
State	:	PR
Zip	:	00961-7041
Country	:	US
Telephone Number	:	787-786-6115
Fax Number	:	787-740-3088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	01/08/2013

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