Provider Demographics
NPI:1073619862
Name:SOHL, BERTRAM E (MD)
Entity Type:Individual
Prefix:DR
First Name:BERTRAM
Middle Name:E
Last Name:SOHL
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 1:1045 ATLANTIC AVE
Mailing Address - Street 2:SUITE 508
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3408
Mailing Address - Country:US
Mailing Address - Phone:562-437-1882
Mailing Address - Fax:562-437-5412
Practice Address - Street 1:1045 ATLANTIC AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3408
Practice Address - Country:US
Practice Address - Phone:562-437-1882
Practice Address - Fax:562-437-5412
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE75434Medicare UPIN
CAWG45556BMedicare ID - Type Unspecified