Provider Demographics
NPI:1003666728
Name:OBAE, JOHN-PAUL (RN)
Entity Type:Individual
Prefix:
First Name:JOHN-PAUL
Middle Name:
Last Name:OBAE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 E PHILLIPS BLVD UNIT 10
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-7553
Mailing Address - Country:US
Mailing Address - Phone:816-694-2924
Mailing Address - Fax:
Practice Address - Street 1:961 E PHILLIPS BLVD UNIT 10
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-7553
Practice Address - Country:US
Practice Address - Phone:816-694-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95184987163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse