Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 23570 | CA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 23570 | CA |
NPI | 1538483995 |
---|---|
Provider Name | Mr. Noel Elatico Sobing |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Santa Monica, CA 90404-1147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2010 |
Last Update Date | 09/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ES322A | MEDICARE ID # (01) | CA |