Provider Demographics
NPI:1508376260
Name:NOVATON, SIXTO JESUS
Entity Type:Individual
Prefix:
First Name:SIXTO
Middle Name:JESUS
Last Name:NOVATON
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 1:7774 118TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-3404
Mailing Address - Country:US
Mailing Address - Phone:561-531-8997
Mailing Address - Fax:904-212-2147
Practice Address - Street 1:7774 118TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-3404
Practice Address - Country:US
Practice Address - Phone:561-531-8997
Practice Address - Fax:904-212-2147
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FL239179374K00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner