Provider Demographics
NPI:1063514313
Name:OBENAUF, GAIL (RD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:OBENAUF
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14870 NEWCASTLE LN
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3207
Mailing Address - Country:US
Mailing Address - Phone:305-575-3270
Mailing Address - Fax:
Practice Address - Street 1:1201 NW 16TH ST- STOP 120
Practice Address - Street 2:DEPT. OF VETERANS' AFFAIRS MEDICAL CENTER
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125
Practice Address - Country:US
Practice Address - Phone:305-575-3270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL719133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered