Healthcare Provider Details

I. General information

NPI: 1164274577
Provider Name (Legal Business Name): JOSELYN OBANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8982 CREEKFORD DR
LAKESIDE CA
92040-3702
US

IV. Provider business mailing address

8755 AERO DR STE 320
SAN DIEGO CA
92123-1764
US

V. Phone/Fax

Practice location:
  • Phone: 916-514-2198
  • Fax:
Mailing address:
  • Phone: 858-256-2180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: