Provider Demographics
NPI:1861548844
Name:SOBOL, PHILIP A (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:SOBOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8618 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4005
Mailing Address - Country:US
Mailing Address - Phone:310-649-5894
Mailing Address - Fax:310-649-5898
Practice Address - Street 1:8618 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045
Practice Address - Country:US
Practice Address - Phone:310-649-5894
Practice Address - Fax:310-649-5898
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42254207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G42254Medicare ID - Type Unspecified
A48883Medicare UPIN