Provider Demographics
NPI:1528377488
Name:NOVIS FOOT COMFORT CENTER
Entity Type:Organization
Organization Name:NOVIS FOOT COMFORT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-796-4971
Mailing Address - Street 1:1836 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3544
Mailing Address - Country:US
Mailing Address - Phone:626-796-4971
Mailing Address - Fax:
Practice Address - Street 1:1836 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3544
Practice Address - Country:US
Practice Address - Phone:626-796-4971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6391520001Medicare NSC