Provider Demographics
NPI:1780174888
Name:NOVUM VALEBAT LLC
Entity type:Organization
Organization Name:NOVUM VALEBAT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-237-3716
Mailing Address - Street 1:1485 S HIGLEY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4786
Mailing Address - Country:US
Mailing Address - Phone:480-237-3716
Mailing Address - Fax:480-658-2382
Practice Address - Street 1:1485 S HIGLEY RD STE 103
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4786
Practice Address - Country:US
Practice Address - Phone:480-237-3716
Practice Address - Fax:480-658-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty