Provider Demographics
NPI:1023841046
Name:OBAGI, SERENE (NP-C)
Entity type:Individual
Prefix:
First Name:SERENE
Middle Name:
Last Name:OBAGI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 GREENFIELD AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3493
Mailing Address - Country:US
Mailing Address - Phone:310-801-6400
Mailing Address - Fax:
Practice Address - Street 1:270 N CANON DR STE 100
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-9395
Practice Address - Country:US
Practice Address - Phone:310-275-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95029666363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner