Basic Information
| Provider Information | |||||||||
| NPI: | 1649452103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOBEL | ||||||||
| FirstName: | JULIANNE | ||||||||
| MiddleName: | MAE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9173 AIRDROME ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900354238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108587733 | ||||||||
| FaxNumber: | 3102731818 | ||||||||
| Practice Location | |||||||||
| Address1: | 9171 WILSHIRE BLVD | ||||||||
| Address2: | PENTHOUSE | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902105530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108587733 | ||||||||
| FaxNumber: | 3102731818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2007 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY11412 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | CP11412C | 01 | CA | MEDICARE PROVIDER NUMBER | OTHER |