Provider Demographics
NPI:1609013853
Name:PORTIA DELA VEGA OBLEA,DMD,INC
Entity Type:Organization
Organization Name:PORTIA DELA VEGA OBLEA,DMD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PORTIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:OBLEA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-993-9939
Mailing Address - Street 1:2356 SENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112
Mailing Address - Country:US
Mailing Address - Phone:408-993-9939
Mailing Address - Fax:408-993-9363
Practice Address - Street 1:2356 SENTER ROAD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112
Practice Address - Country:US
Practice Address - Phone:408-993-9939
Practice Address - Fax:408-993-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty