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General NPI Number Information
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NPI Number | 1467667535
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Entity Type | Individual
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Provider Name | FRED OBEDIAN
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Gender | Male
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 18036 VENTURA BLVD
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City | ENCINO
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State | CA
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Zip | 91316-3516
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Country | US
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Telephone | 818-345-2668
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Fax | 818-345-6480
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Provider Business Mailing Address
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Address Line | 18036 VENTURA BLVD
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City | ENCINO
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State | CA
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Zip | 91316-3516
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Country | US
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Telephone | 818-345-2668
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Fax | 818-345-6480
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 101750
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License Number State | CA
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