Healthcare Provider Details

I. General information

NPI: 1235254889
Provider Name (Legal Business Name): KRISTINA SOBKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14640 VICTORY BLVD #100
VAN NUYS CA
91411-1623
US

IV. Provider business mailing address

7445 CANBY AVE #12
RESEDA CA
91335-2952
US

V. Phone/Fax

Practice location:
  • Phone: 818-374-6901
  • Fax: 818-374-6908
Mailing address:
  • Phone: 818-705-3896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number51167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: