Basic Information
| Provider Information | |||||||||
| NPI: | 1659364958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOBALLE | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | WARREN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2284 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921012107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192551178 | ||||||||
| FaxNumber: | 6195327673 | ||||||||
| Practice Location | |||||||||
| Address1: | 2284 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921012107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192551178 | ||||||||
| FaxNumber: | 6195327673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 12/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | 21560 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.