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General NPI Number Information
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NPI Number | 1831500883
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Entity Type | Organization
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Legal Business Name | NOBLE HEALTHCARE
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 2389 RENAISSANCE DR SUITE A
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City | LAS VEGAS
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State | NV
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Zip | 89119-6106
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Country | US
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Telephone | 170-245-8149
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Fax | 170-245-8786
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Provider Business Mailing Address
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Address Line | 2389 RENAISSANCE DR SUITE A
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City | LAS VEGAS
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State | NV
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Zip | 89119-6106
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Country | US
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Telephone | 170-245-8149
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Fax | 170-245-8786
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN PAUL MOODY III
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Credential | D.C.
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Telephone | 17024581495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | B00793
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License Number State | NV
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