Provider Demographics
NPI:1558768390
Name:DOBALIAN, JUDIE-ANN (NP RNC)
Entity Type:Individual
Prefix:MS
First Name:JUDIE-ANN
Middle Name:
Last Name:DOBALIAN
Suffix:
Gender:F
Credentials:NP RNC
Other - Prefix:
Other - First Name:JUDIE-ANN
Other - Middle Name:
Other - Last Name:FELIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1037 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:631-866-2030
Mailing Address - Fax:631-866-2033
Practice Address - Street 1:6628 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-1715
Practice Address - Country:US
Practice Address - Phone:562-531-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15380363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health