Provider Demographics
NPI:1629079736
Name:NOVOA, JOSE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:NOVOA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:E
Other - Last Name:NOVOA LOYOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:66 CALLE SANTA CRUZ
Mailing Address - Street 2:PLAZA SAN PABLO 1 SUITE 101
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7041
Mailing Address - Country:US
Mailing Address - Phone:787-786-6115
Mailing Address - Fax:787-740-3088
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:PLAZA SAN PABLO I SUITE 101
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-786-6115
Practice Address - Fax:787-740-3088
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11665207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41299Medicare UPIN
PR0088661Medicare ID - Type Unspecified