Provider Demographics
NPI:1962572453
Name:SOBERO, ANA MARIA (DDS)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:MARIA
Last Name:SOBERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34481 DATE PALM DR STE E
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-6842
Mailing Address - Country:US
Mailing Address - Phone:760-324-5071
Mailing Address - Fax:760-324-5877
Practice Address - Street 1:34481 DATE PALM DR STE E
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-6842
Practice Address - Country:US
Practice Address - Phone:760-324-5071
Practice Address - Fax:760-324-5877
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB44366-01Medicaid