Healthcare Provider Details

I. General information

NPI: 1871776229
Provider Name (Legal Business Name): BENILDA BUENAVENTURA OBASOHAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 N EDGEMONT ST
LOS ANGELES CA
90027-5260
US

IV. Provider business mailing address

1526 N EDGEMONT ST
LOS ANGELES CA
90027
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-8070
  • Fax: 323-783-5803
Mailing address:
  • Phone: 323-783-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number33569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: