Provider Demographics
NPI:1407196421
Name:NOVOA, ALBA LEONOR (MA)
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:LEONOR
Last Name:NOVOA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 GREEN VALLEY CIR APT 224
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-8004
Mailing Address - Country:US
Mailing Address - Phone:310-337-9847
Mailing Address - Fax:
Practice Address - Street 1:222 E LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1484
Practice Address - Country:US
Practice Address - Phone:626-320-1317
Practice Address - Fax:626-270-5100
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-12060103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst