1366777989 NPI number — MS. VIOLETA B. OBRA PNP

Table of content: MS. VIOLETA B. OBRA PNP (NPI 1366777989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366777989 NPI number — MS. VIOLETA B. OBRA PNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBRA
Provider First Name:
VIOLETA
Provider Middle Name:
B.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366777989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 CONCORD
Provider Second Line Business Mailing Address:
TERRACE
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-325-5263
Provider Business Mailing Address Fax Number:
954-838-9951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26520 CACTUS AVE
Provider Second Line Business Practice Location Address:
RIVERSIDE COUNTY REGIONAL MEDICAL CENTER PICU
Provider Business Practice Location Address City Name:
MORENO VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-486-5455
Provider Business Practice Location Address Fax Number:
951-486-5680
Provider Enumeration Date:
10/15/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0222X , with the licence number:  8496 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)