=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790440519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NADER SOBH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2021
-----------------------------------------------------
Last Update Date | 11/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1335 N LA BREA AVE STE 3
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90028-7565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-833-3712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1222 N KINGS RD APT 9
-----------------------------------------------------
City | WEST HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90069-2865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-833-3712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | NADER SOBH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 951-833-3712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------