Healthcare Provider Details

I. General information

NPI: 1114265873
Provider Name (Legal Business Name): SOBOL ORTHOPEDIC MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN STREET STE 206
PASADENA CA
91106
US

IV. Provider business mailing address

8618 S SEPULVEDA BLVD STE 130
LOS ANGELES CA
90045
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-8469
  • Fax: 626-449-7910
Mailing address:
  • Phone: 310-649-5894
  • Fax: 310-649-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG42254
License Number StateCA

VIII. Authorized Official

Name: PHILIP ALAN SOBOL
Title or Position: OWNER
Credential: M.D.
Phone: 310-649-5894