Healthcare Provider Details

I. General information

NPI: 1215708839
Provider Name (Legal Business Name): THOMAS BOBADILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21070 STANDING ROCK AVE
APPLE VALLEY CA
92307-3455
US

IV. Provider business mailing address

21070 STANDING ROCK AVE
APPLE VALLEY CA
92307-3455
US

V. Phone/Fax

Practice location:
  • Phone: 760-662-1844
  • Fax:
Mailing address:
  • Phone: 760-662-1844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: