Provider Demographics
NPI:1396828588
Name:NOBILE, LUCIO MANLIO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCIO
Middle Name:MANLIO
Last Name:NOBILE
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 1:6121 N THESTA ST STE 204
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5294
Mailing Address - Country:US
Mailing Address - Phone:559-650-4831
Mailing Address - Fax:559-650-4790
Practice Address - Street 1:7300 N FRESNO -PALM 3
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-9372
Practice Address - Country:US
Practice Address - Phone:559-448-5524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81546207R00000X, 207RX0202X
AL26325207RX0202X
NV20487207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10965331OtherCAQH NUMBER
CAGR0103970Medicaid
CA00A815460Medicaid
CAA81546OtherSTATE LICENSE
NV20487OtherNEVADA MED LICENSE
CAGR0103970Medicaid