Provider Demographics
NPI:1003407388
Name:ADOM TELEPSYCHIATRY AND MENTAL HEALTH SERVICES A PROFESSIONAL NUR
Entity type:Organization
Organization Name:ADOM TELEPSYCHIATRY AND MENTAL HEALTH SERVICES A PROFESSIONAL NUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,BSN, RN, PMHNP-B
Authorized Official - Phone:951-707-7471
Mailing Address - Street 1:PO BOX 77331
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0111
Mailing Address - Country:US
Mailing Address - Phone:951-254-3558
Mailing Address - Fax:
Practice Address - Street 1:4199 FLAT ROCK DR STE 148
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-7115
Practice Address - Country:US
Practice Address - Phone:951-707-7471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)