Provider Demographics
NPI:1154520096
Name:NOVOTA, GABRIELA B (MD)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:B
Last Name:NOVOTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:B
Other - Last Name:FREILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2210 MESA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3701
Mailing Address - Country:US
Mailing Address - Phone:760-736-6767
Mailing Address - Fax:
Practice Address - Street 1:2210 MESA DR STE 300
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3701
Practice Address - Country:US
Practice Address - Phone:760-736-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.117485208000000X
CAC155131208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
367830Medicare PIN