Provider Demographics
NPI:1972937837
Name:NOVOTNY, AVA M (PA-C)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:M
Last Name:NOVOTNY
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:39350 CIVIC CENTER DR
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2331
Mailing Address - Country:US
Mailing Address - Phone:510-797-3933
Mailing Address - Fax:510-797-5184
Practice Address - Street 1:39350 CIVIC CENTER DR
Practice Address - Street 2:SUITE # 300
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2331
Practice Address - Country:US
Practice Address - Phone:228-762-4483
Practice Address - Fax:228-769-0406
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2016-01-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1110125OtherNCCPA CERTIFICATION