Healthcare Provider Details

I. General information

NPI: 1568470854
Provider Name (Legal Business Name): PABLO SOBERO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24430 ALESSANDRO BLVD SUITE 103
MORENO VALLEY CA
92553-2435
US

IV. Provider business mailing address

24430 ALESSANDRO BLVD SUITE 103
MORENO VALLEY CA
92553-2435
US

V. Phone/Fax

Practice location:
  • Phone: 951-485-8490
  • Fax: 951-485-8004
Mailing address:
  • Phone: 951-485-8490
  • Fax: 951-485-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA85824
License Number StateCA

VIII. Authorized Official

Name: PABLO SOBERO
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 951-485-8490