Healthcare Provider Details

I. General information

NPI: 1962167403
Provider Name (Legal Business Name): SILVIA DEYANIRA OBREGON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2021
Last Update Date: 10/31/2021
Certification Date: 10/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4418 EMERALD LAKES BLVD
POWELL OH
43065-7519
US

IV. Provider business mailing address

4418 EMERALD LAKES BLVD
POWELL OH
43065-7519
US

V. Phone/Fax

Practice location:
  • Phone: 305-934-2132
  • Fax:
Mailing address:
  • Phone: 305-934-2132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2105906
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: