Provider Demographics
NPI:1326167651
Name:DR. GARY NOBEL
Entity Type:Organization
Organization Name:DR. GARY NOBEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR'S PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:NOBEL
Authorized Official - Suffix:
Authorized Official - Credentials:C34925
Authorized Official - Phone:858-272-5633
Mailing Address - Street 1:3023 BUNKER HILL ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5706
Mailing Address - Country:US
Mailing Address - Phone:858-272-5633
Mailing Address - Fax:858-272-6574
Practice Address - Street 1:3023 BUNKER HILL ST
Practice Address - Street 2:S103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-5706
Practice Address - Country:US
Practice Address - Phone:858-272-5633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34925284300000X, 332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered284300000XHospitalsSpecial Hospital
Not Answered332900000XSuppliersNon-Pharmacy Dispensing Site