Provider Demographics
NPI:1083401806
Name:NOVALES, JOSE MANUEL
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MANUEL
Last Name:NOVALES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 NW 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4440
Mailing Address - Country:US
Mailing Address - Phone:786-691-7962
Mailing Address - Fax:
Practice Address - Street 1:434 NW 25TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4440
Practice Address - Country:US
Practice Address - Phone:786-691-7962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-361514106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician