Provider Demographics
NPI:1568470854
Name:PABLO SOBERO MD INC
Entity Type:Organization
Organization Name:PABLO SOBERO MD INC
Other - Org Name:RANCHO MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-485-8490
Mailing Address - Street 1:24430 ALESSANDRO BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-2435
Mailing Address - Country:US
Mailing Address - Phone:951-485-8490
Mailing Address - Fax:951-485-8004
Practice Address - Street 1:24430 ALESSANDRO BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-2435
Practice Address - Country:US
Practice Address - Phone:951-485-8490
Practice Address - Fax:951-485-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85824173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2027137Medicaid
ZZZ02479ZMedicare PIN
CA2027137Medicaid