Provider Demographics
NPI:1841734654
Name:OBRIA MEDICAL CLINICS
Entity type:Organization
Organization Name:OBRIA MEDICAL CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:KENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOEHLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-290-9395
Mailing Address - Street 1:1215 E CHAPMAN AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 E CHAPMAN AVE STE 10
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2237
Practice Address - Country:US
Practice Address - Phone:714-516-9045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95104236251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherMEDI-CAL