Provider Demographics
NPI:1568654937
Name:OBLEDO, LAYLA
Entity Type:Individual
Prefix:
First Name:LAYLA
Middle Name:
Last Name:OBLEDO
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 1:10153 1/2 RIVERSIDE DR
Mailing Address - Street 2:#358
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2561
Mailing Address - Country:US
Mailing Address - Phone:760-409-3995
Mailing Address - Fax:
Practice Address - Street 1:10153 1/2 RIVERSIDE DR
Practice Address - Street 2:#358
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2561
Practice Address - Country:US
Practice Address - Phone:760-409-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT40157106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT40157OtherBBS