Provider Demographics
NPI:1699838458
Name:SOBERON, SIDNEY ZABLAN (PT)
Entity Type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:ZABLAN
Last Name:SOBERON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3065 RICHMOND PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5719
Mailing Address - Country:US
Mailing Address - Phone:510-243-2130
Mailing Address - Fax:510-243-2135
Practice Address - Street 1:3065 RICHMOND PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5719
Practice Address - Country:US
Practice Address - Phone:510-243-2130
Practice Address - Fax:510-243-2135
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT258421Medicare PIN