Provider Demographics
NPI:1992928642
Name:OBANDO, MARIA VENUS MEMBRERE (DDS)
Entity type:Individual
Prefix:
First Name:MARIA VENUS
Middle Name:MEMBRERE
Last Name:OBANDO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 E LOMITA AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1857
Mailing Address - Country:US
Mailing Address - Phone:818-613-2680
Mailing Address - Fax:818-247-2764
Practice Address - Street 1:2023 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2417
Practice Address - Country:US
Practice Address - Phone:213-353-9930
Practice Address - Fax:213-353-0990
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice