MEDICARE: MR. SIDNEY ZABLAN SOBERON P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT25842	CA

General Provider Information

NPI Number	:	1699838458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SIDNEY ZABLAN SOBERON P.T.

Provider Business Mailing Address
First Line	:	3065 RICHMOND PKWY
Second Line	:	SUITE 102
City	:	RICHMOND
State	:	CA
Zip	:	94806-5719
Country	:	US
Telephone Number	:	510-243-2130
Fax Number	:	510-243-2135

Provider Business Practice Location Address
First Line	:	3065 RICHMOND PKWY
Second Line	:	SUITE 102
City	:	RICHMOND
State	:	CA
Zip	:	94806-5719
Country	:	US
Telephone Number	:	510-243-2130
Fax Number	:	510-243-2135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	01/30/2019

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