Provider Demographics
NPI:1730561978
Name:NOBLE PHYSICIANS MEDICAL GROUP CORP INC
Entity type:Organization
Organization Name:NOBLE PHYSICIANS MEDICAL GROUP CORP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:LALEZARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-430-4000
Mailing Address - Street 1:PO BOX 251247
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-9747
Mailing Address - Country:US
Mailing Address - Phone:323-938-9999
Mailing Address - Fax:323-456-0880
Practice Address - Street 1:8737 BEVERLY BLVD STE 301
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1839
Practice Address - Country:US
Practice Address - Phone:323-765-1500
Practice Address - Fax:310-363-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA117709OtherMEDICAL LICENSE