Healthcare Provider Details

I. General information

NPI: 1043231442
Provider Name (Legal Business Name): FRANK EDWARD OBULJEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18941 VALLEY DR
VILLA PARK CA
92861-2839
US

IV. Provider business mailing address

18941 VALLEY DR
VILLA PARK CA
92861-2839
US

V. Phone/Fax

Practice location:
  • Phone: 714-637-7988
  • Fax: 714-637-7988
Mailing address:
  • Phone: 714-637-7988
  • Fax: 714-637-7988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberAFE28955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: