Healthcare Provider Details

I. General information

NPI: 1023841046
Provider Name (Legal Business Name): SERENE OBAGI NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 N CANON DR STE 100
BEVERLY HILLS CA
90210-9395
US

IV. Provider business mailing address

1539 GREENFIELD AVE APT 301
LOS ANGELES CA
90025-3493
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-3030
  • Fax:
Mailing address:
  • Phone: 310-801-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95029666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: