Healthcare Provider Details

I. General information

NPI: 1730561978
Provider Name (Legal Business Name): NOBLE PHYSICIANS MEDICAL GROUP CORP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8737 BEVERLY BLVD STE 301
WEST HOLLYWOOD CA
90048-1839
US

IV. Provider business mailing address

PO BOX 251247
LOS ANGELES CA
90025-9747
US

V. Phone/Fax

Practice location:
  • Phone: 323-765-1500
  • Fax: 310-363-7046
Mailing address:
  • Phone: 323-938-9999
  • Fax: 323-456-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA117709
License Number StateCA

VIII. Authorized Official

Name: DAVID BENJAMIN LALEZARI
Title or Position: PRESIDENT
Credential: MD
Phone: 818-430-4000