Provider Demographics
NPI:1679647234
Name:OBISPO, MARIA (NP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:OBISPO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E GRANGER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4347
Mailing Address - Country:US
Mailing Address - Phone:209-589-1500
Mailing Address - Fax:209-521-0813
Practice Address - Street 1:1441 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4404
Practice Address - Country:US
Practice Address - Phone:209-576-3688
Practice Address - Fax:866-364-0091
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451612363L00000X
CANP8053363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4435836Medicaid
CA4435836Medicaid
ZZZ01814ZMedicare PIN