Provider Demographics
NPI:1326225798
Name:NOBELS NEURODIAGNOSTIC MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:NOBELS NEURODIAGNOSTIC MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SION
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-361-0115
Mailing Address - Street 1:10306 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2422
Mailing Address - Country:US
Mailing Address - Phone:818-361-0115
Mailing Address - Fax:818-361-9497
Practice Address - Street 1:10306 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2422
Practice Address - Country:US
Practice Address - Phone:818-361-0115
Practice Address - Fax:818-361-9497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38937305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205940111Medicare PIN