Provider Demographics
NPI:1255496618
Name:SOBO, PAMELA (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:SOBO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18345 VENTURA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4232
Mailing Address - Country:US
Mailing Address - Phone:818-385-0970
Mailing Address - Fax:818-501-7260
Practice Address - Street 1:18345 VENTURA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4232
Practice Address - Country:US
Practice Address - Phone:818-385-0970
Practice Address - Fax:818-501-7260
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17798103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist