Healthcare Provider Details

I. General information

NPI: 1548758709
Provider Name (Legal Business Name): LUCIA ESMERALDA OBREGON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 NW 11TH ST
HERMISTON OR
97838
US

IV. Provider business mailing address

589 NW 11TH ST
HERMISTON OR
97838-6600
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-1717
  • Fax:
Mailing address:
  • Phone: 541-567-1717
  • Fax: 541-564-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201804989NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201803811RN
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95017814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: