Provider Demographics
NPI:1902092596
Name:OBESO, RAMONA B (PA-C)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:B
Last Name:OBESO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39986
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90239-0986
Mailing Address - Country:US
Mailing Address - Phone:562-619-3080
Mailing Address - Fax:562-622-5665
Practice Address - Street 1:1617 E 1ST ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-6385
Practice Address - Country:US
Practice Address - Phone:714-246-0000
Practice Address - Fax:714-541-3525
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 19094363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant