Provider Demographics
NPI:1801273768
Name:NOVAK, ROSEMARIE AGNES (MBA)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:AGNES
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 BELLINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-3676
Mailing Address - Country:US
Mailing Address - Phone:818-859-0664
Mailing Address - Fax:
Practice Address - Street 1:7411 BELLINGHAM AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-3676
Practice Address - Country:US
Practice Address - Phone:818-859-0664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0I03043251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare