Provider Demographics
NPI:1922392547
Name:NOVO
Entity Type:Organization
Organization Name:NOVO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:408-281-0708
Mailing Address - Street 1:90 GREAT OAKS BLVD
Mailing Address - Street 2:108
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1314
Mailing Address - Country:US
Mailing Address - Phone:408-281-0708
Mailing Address - Fax:408-281-2658
Practice Address - Street 1:258 SUNOL ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-4804
Practice Address - Country:US
Practice Address - Phone:408-281-0708
Practice Address - Fax:408-281-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health