Provider Demographics
NPI:1235104860
Name:CARDOZA-FAVARATO, GABRIELLA (MD)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:CARDOZA-FAVARATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0071
Mailing Address - Country:US
Mailing Address - Phone:210-437-2578
Mailing Address - Fax:
Practice Address - Street 1:4002 VISTA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4506
Practice Address - Country:US
Practice Address - Phone:760-634-3230
Practice Address - Fax:858-794-4061
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD193952207ZP0102X
CAA74694207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology