MEDICARE: MS. JUDIE-ANN DOBALIAN NP RNC

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	363LW0102X	Women's Health Nurse Practitioner	15380	CA

General Provider Information

NPI Number	:	1558768390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDIE-ANN DOBALIAN NP RNC

Provider Business Mailing Address
First Line	:	1037 MAIN ST
Second Line	:
City	:	PEEKSKILL
State	:	NY
Zip	:	10566-2913
Country	:	US
Telephone Number	:	631-866-2030
Fax Number	:	631-866-2033

Provider Business Practice Location Address
First Line	:	6628 CHERRY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1715
Country	:	US
Telephone Number	:	562-531-3160
Fax Number	:

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

Provider Enumeration Date	:	11/21/2014
Last Update Date	:	02/11/2017

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