Provider Demographics
NPI:1104611805
Name:SOBA, MARIBEL
Entity type:Individual
Prefix:MISS
First Name:MARIBEL
Middle Name:
Last Name:SOBA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 13801
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9752
Mailing Address - Country:US
Mailing Address - Phone:787-376-1597
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 13801
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-9752
Practice Address - Country:US
Practice Address - Phone:787-376-1597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004986183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician