Healthcare Provider Details

I. General information

NPI: 1366777989
Provider Name (Legal Business Name): VIOLETA B. OBRA PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE RIVERSIDE COUNTY REGIONAL MEDICAL CENTER PICU
MORENO VALLEY CA
92555
US

IV. Provider business mailing address

1301 CONCORD TERRACE
SUNRISE FL
33323
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-5455
  • Fax: 951-486-5680
Mailing address:
  • Phone: 954-325-5263
  • Fax: 954-838-9951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number8496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: