Healthcare Provider Details

I. General information

NPI: 1790440519
Provider Name (Legal Business Name): NADER SOBH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 N LA BREA AVE STE 3
LOS ANGELES CA
90028-7565
US

IV. Provider business mailing address

1222 N KINGS RD APT 9
WEST HOLLYWOOD CA
90069-2865
US

V. Phone/Fax

Practice location:
  • Phone: 951-833-3712
  • Fax:
Mailing address:
  • Phone: 951-833-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NADER SOBH
Title or Position: PHYSICIAN
Credential:
Phone: 951-833-3712