Provider Demographics
NPI:1689601270
Name:NOVAK, LOREN (DO)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:NOVAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 SYCAMORE AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7832
Mailing Address - Country:US
Mailing Address - Phone:760-598-1700
Mailing Address - Fax:760-598-1196
Practice Address - Street 1:910 SYCAMORE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7832
Practice Address - Country:US
Practice Address - Phone:760-598-1700
Practice Address - Fax:760-598-1196
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00287181OtherRAILROAD MEDICARE
CA00AX68680Medicaid
CA5995990OtherGHI
CAG88252Medicare UPIN
CAW20A6868BMedicare PIN
CA00AX68680Medicaid
CABK788ZMedicare PIN