Provider Demographics
NPI:1013213255
Name:NOVENCIDO, LEMUEL LOPEZ
Entity Type:Individual
Prefix:
First Name:LEMUEL
Middle Name:LOPEZ
Last Name:NOVENCIDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-4418
Mailing Address - Country:US
Mailing Address - Phone:760-994-3378
Mailing Address - Fax:
Practice Address - Street 1:106 MONROE ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-4418
Practice Address - Country:US
Practice Address - Phone:760-994-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist