Provider Demographics
NPI:1902681240
Name:NOVERO, JEDRICK LLEVARES
Entity Type:Individual
Prefix:
First Name:JEDRICK
Middle Name:LLEVARES
Last Name:NOVERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 SANTA THERESA CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4130
Mailing Address - Country:US
Mailing Address - Phone:619-755-8120
Mailing Address - Fax:
Practice Address - Street 1:572 SANTA THERESA CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4130
Practice Address - Country:US
Practice Address - Phone:619-755-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports