Healthcare Provider Details

I. General information

NPI: 1235478074
Provider Name (Legal Business Name): SHEILA B SOBRETODO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19232 CHESTRIDGE CIR
WALNUT CA
91789-4188
US

IV. Provider business mailing address

19232 CHESTRIDGE CIR
WALNUT CA
91789-4188
US

V. Phone/Fax

Practice location:
  • Phone: 626-327-1380
  • Fax:
Mailing address:
  • Phone: 626-327-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19015
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number342093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: