Provider Demographics
NPI:1356559553
Name:OBENG, GLADYS K (DNP, BSN, RN, PMHNP-)
Entity type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:K
Last Name:OBENG
Suffix:
Gender:F
Credentials:DNP, BSN, RN, PMHNP-
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 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:951-707-7471
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011262363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health