Provider Demographics
NPI:1669227138
Name:OBMINA JOSUE, EDWARD FREDERICK CASAREO (RN)
Entity type:Individual
Prefix:MR
First Name:EDWARD FREDERICK
Middle Name:CASAREO
Last Name:OBMINA JOSUE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:CASAREO
Other - Last Name:OBMINA JOSUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1370 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-4933
Mailing Address - Country:US
Mailing Address - Phone:951-791-3596
Mailing Address - Fax:951-791-3357
Practice Address - Street 1:1370 S STATE ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-4933
Practice Address - Country:US
Practice Address - Phone:951-791-3596
Practice Address - Fax:951-791-3357
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512176163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse