Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | AFE28955 | CA |
NPI | 1043231442 |
---|---|
Provider Name | Frank Edward Obuljen |
First Address | Villa Park, CA 92861-2839 |
Second Address | Villa Park, CA 92861-2839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 05/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A-25608 | (02) | CA |