Provider Demographics
NPI:1346586906
Name:HELENE NOVESTERAS MD A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:HELENE NOVESTERAS MD A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVESTERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-833-3386
Mailing Address - Street 1:1530 BESSIE AVE
Mailing Address - Street 2:# 106
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3080
Mailing Address - Country:US
Mailing Address - Phone:209-833-3386
Mailing Address - Fax:209-835-9440
Practice Address - Street 1:1530 BESSIE AVE
Practice Address - Street 2:# 106
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3080
Practice Address - Country:US
Practice Address - Phone:209-833-3386
Practice Address - Fax:209-835-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051250305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization