Healthcare Provider Details

I. General information

NPI: 1538235718
Provider Name (Legal Business Name): PAUL BARRY SOGOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PAUL BARRY SOGOL MD

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18840 VENTURA BLVD STE 207
TARZANA CA
91356-3381
US

IV. Provider business mailing address

18840 VENTURA BLVD STE 207
TARZANA CA
91356-3381
US

V. Phone/Fax

Practice location:
  • Phone: 818-776-2627
  • Fax: 818-776-9861
Mailing address:
  • Phone: 818-776-2627
  • Fax: 818-776-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number00G39246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: