Provider Demographics
NPI:1609317163
Name:OBANDO, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:OBANDO
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 1:9905 KARMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-5414
Mailing Address - Country:US
Mailing Address - Phone:562-441-2115
Mailing Address - Fax:
Practice Address - Street 1:12440 FIRESTONE BLVD
Practice Address - Street 2:#3020
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4328
Practice Address - Country:US
Practice Address - Phone:562-864-7821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program