Healthcare Provider Details

I. General information

NPI: 1093168742
Provider Name (Legal Business Name): ASHLEY OBRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date: 06/13/2024
Reactivation Date: 07/19/2024

III. Provider practice location address

232 E GISH RD
SAN JOSE CA
95112-4706
US

IV. Provider business mailing address

1769 PARK AVE STE 250
SAN JOSE CA
95126-2030
US

V. Phone/Fax

Practice location:
  • Phone: 669-302-9937
  • Fax:
Mailing address:
  • Phone: 510-426-6149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: