Provider Demographics
NPI:1831291632
Name:SOBEL, IRVING (MD)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:
Last Name:SOBEL
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 1:4644 LINCOLN BLVD
Mailing Address - Street 2:114
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6313
Mailing Address - Country:US
Mailing Address - Phone:310-821-9800
Mailing Address - Fax:310-437-6423
Practice Address - Street 1:4644 LINCOLN BLVD
Practice Address - Street 2:114
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6313
Practice Address - Country:US
Practice Address - Phone:310-821-9800
Practice Address - Fax:310-437-6423
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0026910Medicaid
CAG40404Medicare PIN
CAGR0026910Medicaid