Healthcare Provider Details

I. General information

NPI: 1992928642
Provider Name (Legal Business Name): MARIA VENUS MEMBRERE OBANDO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 BEVERLY BLVD
LOS ANGELES CA
90057-2417
US

IV. Provider business mailing address

1007 E LOMITA AVE APT 210
GLENDALE CA
91205-1857
US

V. Phone/Fax

Practice location:
  • Phone: 213-353-9930
  • Fax: 213-353-0990
Mailing address:
  • Phone: 818-613-2680
  • Fax: 818-247-2764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number49962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: