Provider Demographics
NPI:1437434016
Name:NOVALL, GREGORY B
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:B
Last Name:NOVALL
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 1:750 N COMMONS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7940
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:2465 E PALM CANYON DR
Practice Address - Street 2:BLDG 5, STE 500
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-7002
Practice Address - Country:US
Practice Address - Phone:760-322-9533
Practice Address - Fax:760-406-5939
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4110237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist