Provider Demographics
NPI:1669743506
Name:OBLITAS, PAULINE (PA-C)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:OBLITAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:
Other - Last Name:ZALOUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:501 S. BUENA VISTA ST.
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505
Mailing Address - Country:US
Mailing Address - Phone:818-847-4055
Mailing Address - Fax:818-848-4320
Practice Address - Street 1:501 S. BUENA VISTA ST.
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505
Practice Address - Country:US
Practice Address - Phone:818-847-4055
Practice Address - Fax:818-848-4320
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant