MEDICARE: MS. OFRA OBEJAS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	60551	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCS 60551	OTHER	CA	STATE LICENSURE

General Provider Information

NPI Number	:	1316062920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. OFRA OBEJAS LCSW

Provider Business Mailing Address
First Line	:	1711 VIA EL PRADO STE 202
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5721
Country	:	US
Telephone Number	:	310-503-1884
Fax Number	:	310-373-5972

Provider Business Practice Location Address
First Line	:	1711 VIA EL PRADO STE 202
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5721
Country	:	US
Telephone Number	:	310-503-1884
Fax Number	:	310-373-5972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	06/19/2019

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