Provider Demographics
NPI:1487393500
Name:OBDI HEALTHCARE INC
Entity type:Organization
Organization Name:OBDI HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:909-938-9925
Mailing Address - Street 1:10722 ARROW RTE STE 512
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4840
Mailing Address - Country:US
Mailing Address - Phone:909-315-6431
Mailing Address - Fax:909-989-2499
Practice Address - Street 1:10722 ARROW RTE STE 512
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4840
Practice Address - Country:US
Practice Address - Phone:951-204-0909
Practice Address - Fax:909-889-2816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service