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General NPI Number Information
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NPI Number | 1144461823
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Entity Type | Organization
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Legal Business Name | MARILOU R. SOBRERA, M.D., INC.
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 18300 US HIGHWAY 18
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City | APPLE VALLEY
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State | CA
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Zip | 92307-2206
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Country | US
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Telephone | 760-242-2311
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Fax | 760-242-9167
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Provider Business Mailing Address
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Address Line | PO BOX 60790
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City | PASADENA
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State | CA
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Zip | 91116-6790
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Country | US
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Telephone | 818-845-6206
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Fax | 626-396-0851
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARILOU ROSALES SOBRERA
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Credential | M.D.
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Telephone | 760-953-7462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A37096
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License Number State | CA
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