Provider Demographics
NPI:1720031388
Name:NOVAK, ADAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:J
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 W FOOTHILL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3785
Mailing Address - Country:US
Mailing Address - Phone:909-931-0069
Mailing Address - Fax:909-625-4954
Practice Address - Street 1:914 W FOOTHILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3785
Practice Address - Country:US
Practice Address - Phone:909-931-0069
Practice Address - Fax:909-625-4954
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A448351Medicaid
CAF03301Medicare UPIN
CA00A448351Medicaid