Provider Demographics
NPI:1386235059
Name:SOBO, DORCAS FUNSO
Entity type:Individual
Prefix:
First Name:DORCAS
Middle Name:FUNSO
Last Name:SOBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 RIO BONITO RD APT 194
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1574
Mailing Address - Country:US
Mailing Address - Phone:832-343-0820
Mailing Address - Fax:
Practice Address - Street 1:14100 RIO BONITO RD APT 194
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-1574
Practice Address - Country:US
Practice Address - Phone:832-343-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X
TX1121627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist