Provider Demographics
NPI:1437149549
Name:OBV AT FILLMORE, INC
Entity Type:Organization
Organization Name:OBV AT FILLMORE, INC
Other - Org Name:PRIORITY HEALTHCARE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANANIAS
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-525-8900
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93016-0389
Mailing Address - Country:US
Mailing Address - Phone:805-525-8900
Mailing Address - Fax:805-524-1321
Practice Address - Street 1:1371 BLUEJAY ST
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1666
Practice Address - Country:US
Practice Address - Phone:805-525-8900
Practice Address - Fax:805-524-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization