Provider Demographics
NPI:1780132456
Name:NOVA ROSA, JAVIER (BSN RN)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:NOVA ROSA
Suffix:
Gender:M
Credentials:BSN RN
Other - Prefix:
Other - First Name:NOVA
Other - Middle Name:
Other - Last Name:CLAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1980 ALLSTON WAY # H-105
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1463
Mailing Address - Country:US
Mailing Address - Phone:510-644-6965
Mailing Address - Fax:206-252-7701
Practice Address - Street 1:1980 ALLSTON WAY # H-105
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1463
Practice Address - Country:US
Practice Address - Phone:510-644-6965
Practice Address - Fax:206-252-7701
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60656273163WS0200X
CA95171572163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool