Healthcare Provider Details

I. General information

NPI: 1225382054
Provider Name (Legal Business Name): OBAND, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 ADMIRALTY WAY
MARINA DEL REY CA
90292-5469
US

IV. Provider business mailing address

4333 ADMIRALTY WAY
MARINA DEL REY CA
90292-5469
US

V. Phone/Fax

Practice location:
  • Phone: 310-821-2549
  • Fax:
Mailing address:
  • Phone: 310-821-2549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ISAAC VERBUKH
Title or Position: PRESIDENT
Credential:
Phone: 310-821-2549