Healthcare Provider Details

I. General information

NPI: 1558768390
Provider Name (Legal Business Name): JUDIE-ANN DOBALIAN NP RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDIE-ANN FELIX

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 02/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6628 CHERRY AVE
LONG BEACH CA
90805-1715
US

IV. Provider business mailing address

1037 MAIN ST
PEEKSKILL NY
10566-2913
US

V. Phone/Fax

Practice location:
  • Phone: 562-531-3160
  • Fax:
Mailing address:
  • Phone: 631-866-2030
  • Fax: 631-866-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number15380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: