Provider Demographics
NPI:1598957425
Name:JAY A NOBLE MD INC
Entity Type:Organization
Organization Name:JAY A NOBLE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-446-0171
Mailing Address - Street 1:622 W DUARTE RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7606
Mailing Address - Country:US
Mailing Address - Phone:626-446-0171
Mailing Address - Fax:
Practice Address - Street 1:622 W DUARTE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7606
Practice Address - Country:US
Practice Address - Phone:626-446-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG9439174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty