Provider Demographics
NPI:1730712050
Name:OBIALISI, CONSTANCE (DNP)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:
Last Name:OBIALISI
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 SEPULVEDA BLVD APT 114
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-3423
Mailing Address - Country:US
Mailing Address - Phone:818-906-4310
Mailing Address - Fax:
Practice Address - Street 1:5307 SEPULVEDA BLVD APT 114
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-3423
Practice Address - Country:US
Practice Address - Phone:818-906-4310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily