Provider Demographics
NPI:1164413803
Name:NOVOA, JULIO C (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:C
Last Name:NOVOA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10781 PEBBLE HILLS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-2038
Mailing Address - Country:US
Mailing Address - Phone:915-595-9944
Mailing Address - Fax:915-595-9944
Practice Address - Street 1:10781 PEBBLE HILLS BLVD STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-2038
Practice Address - Country:US
Practice Address - Phone:915-595-9944
Practice Address - Fax:915-595-9944
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8386207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX810590634OtherTAX ID
TX0039JYOtherBC/BS PROVIDER NUMBER
TX91252075OtherNEW MEXICO MEDICAID #
TX040148103Medicaid
TX810590634OtherTAX ID
TX91252075OtherNEW MEXICO MEDICAID #