Individual
DR. JASON LYLE NOVICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
525 CAPITOLA AVE, UNIT B, CAPITOLA, CA 95010-2759
(831) 462-2132
(831) 462-2930
Mailing address
525 CAPITOLA AVE, UNIT B, CAPITOLA, CA 95010-2759
(831) 462-2132
(831) 462-2930
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E4661
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00363267
RAIL ROAD MEDICARE GROUP MEMBER PTAN
CA
Enumeration date
04/25/2006
Last updated
10/04/2012
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