Provider Demographics
NPI:1811060064
Name:NOBLE, RANDOLPH H (MD)
Entity type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:H
Last Name:NOBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15840 VENTURA BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2932
Mailing Address - Country:US
Mailing Address - Phone:818-986-8714
Mailing Address - Fax:818-385-1459
Practice Address - Street 1:15840 VENTURA BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2932
Practice Address - Country:US
Practice Address - Phone:818-986-8714
Practice Address - Fax:818-385-1459
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26017207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26017AMedicare ID - Type Unspecified
CAA24677Medicare UPIN