Provider Demographics
NPI:1477821965
Name:PAULIN OBAS, ISLANDE
Entity Type:Individual
Prefix:
First Name:ISLANDE
Middle Name:
Last Name:PAULIN OBAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19509 STAGE LINE TRL
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2954
Mailing Address - Country:US
Mailing Address - Phone:713-578-0140
Mailing Address - Fax:
Practice Address - Street 1:19509 STAGE LINE TRL
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2954
Practice Address - Country:US
Practice Address - Phone:713-578-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX758936372600000X
TXNA08634695374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide