Provider Demographics
NPI:1801440292
Name:OBANA, BRENDA VENDIOLA (NP)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:VENDIOLA
Last Name:OBANA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11758 LANDSDOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4161
Mailing Address - Country:US
Mailing Address - Phone:909-557-7879
Mailing Address - Fax:
Practice Address - Street 1:11758 LANDSDOWN RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4161
Practice Address - Country:US
Practice Address - Phone:909-557-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499982163W00000X
CA95014138363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse