Provider Demographics
NPI:1376838219
Name:SOBIN, REBECCA (DAOM, LAC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SOBIN
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43522
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3522
Mailing Address - Country:US
Mailing Address - Phone:406-579-4640
Mailing Address - Fax:
Practice Address - Street 1:13920 S LOCKPORT AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85736-1413
Practice Address - Country:US
Practice Address - Phone:406-579-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT166171100000X
ORACO1199171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0863OtherACUPUNCTURE LICENSE