Healthcare Provider Details

I. General information

NPI: 1659430247
Provider Name (Legal Business Name): VALENTINA OBRADOVIC DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 W SAN MARCES BLVD #110
SAN MARCOS CA
92078
US

IV. Provider business mailing address

960 W SAN MARCES BLVD #110
SAN MARCOS CA
92078
US

V. Phone/Fax

Practice location:
  • Phone: 760-591-3434
  • Fax: 760-591-3465
Mailing address:
  • Phone: 760-591-3434
  • Fax: 760-591-3465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: