Provider Demographics
NPI:1265404081
Name:SOGBEIN, PATRICK ADEBOWALE
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ADEBOWALE
Last Name:SOGBEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13615 VICTORY BLVD
Mailing Address - Street 2:SUITE 136
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1737
Mailing Address - Country:US
Mailing Address - Phone:818-376-1243
Mailing Address - Fax:818-376-1604
Practice Address - Street 1:13615 VICTORY BLVD
Practice Address - Street 2:SUITE136
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1737
Practice Address - Country:US
Practice Address - Phone:818-376-1243
Practice Address - Fax:818-376-1604
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102908332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4802910001Medicare NSC