Provider Demographics
NPI:1790670222
Name:NOBLITT, JAMES RANDALL
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RANDALL
Last Name:NOBLITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5224 N BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2014
Mailing Address - Country:US
Mailing Address - Phone:310-614-7895
Mailing Address - Fax:
Practice Address - Street 1:5224 N BURTON AVE
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-2014
Practice Address - Country:US
Practice Address - Phone:310-614-7895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22565103TC0700X
NMPSY-2024-0064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical