Provider Demographics
NPI:1245770270
Name:OBANA, STEPHEN STEWART
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:STEWART
Last Name:OBANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11758 LANDSDOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4161
Mailing Address - Country:US
Mailing Address - Phone:909-747-4706
Mailing Address - Fax:
Practice Address - Street 1:11758 LANDSDOWN RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4161
Practice Address - Country:US
Practice Address - Phone:909-747-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48528225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant