Basic Information
Provider Information
NPI: 1407219033
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOBGA-PASIAH
FirstName: EMILIA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3400 DATA DR
Address2:  
City: RANCHO CORDOVA
State: CA
PostalCode: 956707956
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 18460 ROSCOE BLVD FL 2-3
Address2:  
City: NORTHRIDGE
State: CA
PostalCode: 913254107
CountryCode: US
TelephoneNumber: 8188855480
FaxNumber: 8189931917
Other Information
ProviderEnumerationDate: 03/31/2016
LastUpdateDate: 02/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XA158544CAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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