Healthcare Provider Details

I. General information

NPI: 1316008584
Provider Name (Legal Business Name): ELIZABETH R OBOLENSKY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W MACARTHUR BLVD KAISER PERMANENTE OAKLAND MEDICAL CENTER
OAKLAND CA
94611-5641
US

IV. Provider business mailing address

275 W MACARTHUR BLVD KAISER PERMANENTE OAKLAND MEDICAL CENTER
OAKLAND CA
94611-5641
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-6298
  • Fax: 510-752-6754
Mailing address:
  • Phone: 510-752-6298
  • Fax: 510-752-6754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: