Healthcare Provider Details

I. General information

NPI: 1558242487
Provider Name (Legal Business Name): IVANA ALINA OBIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 NAJOLES RD STE K-M
MILLERSVILLE MD
21108-2676
US

IV. Provider business mailing address

7120 SAMUEL MORSE DR STE 150
COLUMBIA MD
21046-3420
US

V. Phone/Fax

Practice location:
  • Phone: 888-344-5977
  • Fax:
Mailing address:
  • Phone: 888-344-5977
  • Fax: 999-999-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: