Healthcare Provider Details

I. General information

NPI: 1194545715
Provider Name (Legal Business Name): ELENA OBREGON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 SW 107TH AVE APT 156W
MIAMI FL
33173-4382
US

IV. Provider business mailing address

8415 SW 107TH AVE APT 156W
MIAMI FL
33173-4382
US

V. Phone/Fax

Practice location:
  • Phone: 786-999-9098
  • Fax:
Mailing address:
  • Phone: 786-999-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License NumberRN9390910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: