MEDICARE: MARIA VENUS MEMBRERE OBANDO D.D.S.

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	1223G0001X	General Practice Dentistry	49962	CA

General Provider Information

NPI Number	:	1992928642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA VENUS MEMBRERE OBANDO D.D.S.

Provider Business Mailing Address
First Line	:	1007 E LOMITA AVE APT 210
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1857
Country	:	US
Telephone Number	:	818-613-2680
Fax Number	:	818-247-2764

Provider Business Practice Location Address
First Line	:	2023 BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2417
Country	:	US
Telephone Number	:	213-353-9930
Fax Number	:	213-353-0990

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/20/2007

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