Individual
ENRICO C SOBONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1180 N INDIAN CANYON DR, STE E 218, PALM SPRINGS, CA 92262-4835
(760) 416-4866
Mailing address
620 GOLD CANYON DR, PALM DESERT, CA 92211-5902
(616) 954-9800
(616) 954-2116
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
4301037733
MI
174400000X
Specialist
Primary
C53891
CA
207RX0202X
Medical Oncology Physician
4301037733
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900004368
RR MEDICARE
MI
Enumeration date
08/09/2005
Last updated
04/27/2011
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