Provider Demographics
NPI:1336292507
Name:OBLALISI, CHARLES EBERE (LVN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EBERE
Last Name:OBLALISI
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 BELFORD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4313
Mailing Address - Country:US
Mailing Address - Phone:310-216-7495
Mailing Address - Fax:310-216-7495
Practice Address - Street 1:15317 FREEMAN AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260
Practice Address - Country:US
Practice Address - Phone:310-679-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN178143164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse