Healthcare Provider Details

I. General information

NPI: 1912436437
Provider Name (Legal Business Name): DANIEL OBA PASCUAL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD STE 200
HARBOR CITY CA
90710-2086
US

IV. Provider business mailing address

1403 LOMITA BLVD STE 200
HARBOR CITY CA
90710-2086
US

V. Phone/Fax

Practice location:
  • Phone: 310-534-6250
  • Fax: 310-539-3857
Mailing address:
  • Phone: 310-534-6250
  • Fax: 310-539-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number722506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: