| Noble Physicians Medical Group Corp Inc | |
|
5901 W Olympic Blvd Ste 404 Los Angeles CA 90036-4669 | |
| (323) 938-9999 | |
| (323) 456-0880 |
| Full Name | Noble Physicians Medical Group Corp Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5901 W Olympic Blvd Ste 404, Los Angeles, California |
| Authorized Official Name and Position | David Benjamin Lalezari (PRESIDENT) |
| Authorized Official Contact | 8184304000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Noble Physicians Medical Group Corp Inc Po Box 251247 Los Angeles CA 90025-9747 Ph: (323) 938-9999 | Noble Physicians Medical Group Corp Inc 5901 W Olympic Blvd Ste 404 Los Angeles CA 90036-4669 Ph: (323) 938-9999 |
| NPI Number | 1730561978 |
|---|---|
| Provider Enumeration Date | 06/24/2015 |
| Last Update Date | 01/29/2020 |
| Medicare PECOS PAC ID | 2860706348 |
|---|---|
| Medicare Enrollment ID | O20150728004383 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730561978 | NPI | - | NPPES |
| A117709 | Other | CA | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A117709 (California) | Primary |
| Provider Name | David B Lalezari |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093094427 PECOS PAC ID: 7719113273 Enrollment ID: I20131112000994 |
| Provider Name | Daniel Ayala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497247332 PECOS PAC ID: 6002214731 Enrollment ID: I20211012000448 |
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