MEDICARE: PHILIP A SOBOL MD

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	207X00000X	Orthopaedic Surgery Physician	G42254	CA

General Provider Information

NPI Number	:	1861548844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP A SOBOL MD

Provider Business Mailing Address
First Line	:	8618 S SEPULVEDA BLVD
Second Line	:	SUITE 130
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4005
Country	:	US
Telephone Number	:	310-649-5894
Fax Number	:	310-649-5898

Provider Business Practice Location Address
First Line	:	8618 S SEPULVEDA BLVD
Second Line	:	SUITE 130
City	:	LOS ANGELES
State	:	CA
Zip	:	90045
Country	:	US
Telephone Number	:	310-649-5894
Fax Number	:	310-649-5898

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	12/11/2007

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