Healthcare Provider Details

I. General information

NPI: 1326167651
Provider Name (Legal Business Name): DR. GARY NOBEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 BUNKER HILL ST S103
SAN DIEGO CA
92109-5706
US

IV. Provider business mailing address

3023 BUNKER HILL ST SUITE #103
SAN DIEGO CA
92109-5706
US

V. Phone/Fax

Practice location:
  • Phone: 858-272-5633
  • Fax:
Mailing address:
  • Phone: 858-272-5633
  • Fax: 858-272-6574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License NumberC34925
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberC34925
License Number StateCA

VIII. Authorized Official

Name: DR. GARY L NOBEL
Title or Position: DOCTOR'S PRACTICE
Credential: C34925
Phone: 858-272-5633