Individual
ANDREW NOVENCIDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
1155 13TH ST, IMPERIAL BEACH, CA 91932-3608
(619) 941-2680
Mailing address
343 CRESTVIEW DR, BONITA, CA 91902-4253
(619) 339-2974
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
295915
CA
Other
Enumeration date
01/07/2019
Last updated
01/07/2019
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