Provider Demographics
NPI:1093933939
Name:NOBLE CARE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:NOBLE CARE MEDICAL GROUP, INC
Other - Org Name:SAN FERNANDO MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PARTOVY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-709-4890
Mailing Address - Street 1:PO BOX 920970
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91392-0970
Mailing Address - Country:US
Mailing Address - Phone:818-361-3788
Mailing Address - Fax:818-361-4630
Practice Address - Street 1:501 N MACLAY AVE
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-2424
Practice Address - Country:US
Practice Address - Phone:818-361-3788
Practice Address - Fax:818-361-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063591477OtherINDIVIDUAL NPI NUMBER
CA00AX70330Medicaid
CA00AX70330Medicaid
W18509Medicare PIN