1073636817 NPI number — SOBOL ORTHOPEDIC MEDICAL GROUP, INC.

Table of content: DR. MICHAEL LEE FERREBEE MD (NPI 1649352451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073636817 NPI number — SOBOL ORTHOPEDIC MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOBOL ORTHOPEDIC MEDICAL GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073636817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8618 S SEPULVEDA BLVD
Provider Second Line Business Practice Location Address:
STE. 130
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90045-4005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-649-5894
Provider Business Practice Location Address Fax Number:
310-649-1094
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOBOL
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-649-5894

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  G42254 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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