Healthcare Provider Details

I. General information

NPI: 1487205100
Provider Name (Legal Business Name): IAN LUKE NOOL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BERN CT STE 130
SAN JOSE CA
95112-1242
US

IV. Provider business mailing address

1241 PECOS WAY
SUNNYVALE CA
94089-2301
US

V. Phone/Fax

Practice location:
  • Phone: 408-437-8864
  • Fax:
Mailing address:
  • Phone: 408-437-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: