Provider Demographics
NPI:1285149260
Name:SOBERAL, JUAN LUIS II (PT, DPT, FAFS)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:LUIS
Last Name:SOBERAL
Suffix:II
Gender:M
Credentials:PT, DPT, FAFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 OCEAN PARK BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5217
Mailing Address - Country:US
Mailing Address - Phone:310-392-0025
Mailing Address - Fax:
Practice Address - Street 1:2701 OCEAN PARK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5217
Practice Address - Country:US
Practice Address - Phone:310-392-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist