1699077438 NPI number — MELVYN H. NOVEGROD, M.D., INC.

Table of content: (NPI 1699077438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699077438 NPI number — MELVYN H. NOVEGROD, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELVYN H. NOVEGROD, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699077438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11160 WARNER AVE
Provider Second Line Business Mailing Address:
401
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-4008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-546-1121
Provider Business Mailing Address Fax Number:
714-546-0428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11160 WARNER AVE
Provider Second Line Business Practice Location Address:
401
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-4008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-546-1121
Provider Business Practice Location Address Fax Number:
714-546-0428
Provider Enumeration Date:
11/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HOVEY
Authorized Official First Name:
REGINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
714-546-1121

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ64428Y . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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