1649452103 NPI number — DR. JULIANNE MAE SOBEL PSY.D.

Table of content: JOHANNA JOI PARAISO (NPI 1558095729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649452103 NPI number — DR. JULIANNE MAE SOBEL PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOBEL
Provider First Name:
JULIANNE
Provider Middle Name:
MAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

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:
1649452103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9173 AIRDROME ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90035-4238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-858-7733
Provider Business Mailing Address Fax Number:
310-273-1818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9171 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
PENTHOUSE
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90210-5530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-858-7733
Provider Business Practice Location Address Fax Number:
310-273-1818
Provider Enumeration Date:
11/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY11412 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CP11412C . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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