Doctor Name: | DR. ROBERT EUGENE SODERBLOM |
NPI Number: | 1386749067 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | G12254 |
Business Practice Address: | 11201 Benton St 111n Loma Linda, CA - 923571000 |
Business Phone Number: | 9098257084 |
Business Fax Number: | 9097773858 |
Mailing Address: | 34394 La Raye Dr, YUCAIPA |
State: | CA |
Postal Code: | 923995023 |
Phone Number: | 9098357084 |
Fax Number: | 9097773858 |
NPI Enumeration Date: | 09/14/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | G12254 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |