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General NPI Number Information
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NPI Number | 1821875956
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Entity Type | Individual
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Provider Name | NOBLE ISAC
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Gender | Male
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 3463 MAGIC DR STE T21
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3621
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Country | US
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Telephone | 210-614-8101
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Fax |
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Provider Business Mailing Address
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Address Line | 658 EMERALD FOREST CIR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-5849
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Country | US
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Telephone | 980-263-1795
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 242T00000X
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Taxonomy Name | Perfusionist
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License Number | FPF02000268
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License Number State | TX
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