Provider Demographics
NPI:1578367892
Name:COBELO, SEBASTIAN
Entity type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:
Last Name:COBELO
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 1:1124 N GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-2513
Mailing Address - Country:US
Mailing Address - Phone:918-978-3663
Mailing Address - Fax:
Practice Address - Street 1:1124 N GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-2513
Practice Address - Country:US
Practice Address - Phone:918-978-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty