Provider Demographics
NPI:1245246412
Name:NOVERO, CARLETTE P (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLETTE
Middle Name:P
Last Name:NOVERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 VERDUGO RD
Mailing Address - Street 2:APT 4
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4724
Mailing Address - Country:US
Mailing Address - Phone:315-254-3794
Mailing Address - Fax:
Practice Address - Street 1:3160 E DEL MAR BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4649
Practice Address - Country:US
Practice Address - Phone:626-398-6300
Practice Address - Fax:626-204-0086
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT185618207R00000X
CAA108994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871689315Medicaid