Healthcare Provider Details

I. General information

NPI: 1255185062
Provider Name (Legal Business Name): JUSTIN BOBILA PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16020 CARRARA LN
FONTANA CA
92336-4638
US

IV. Provider business mailing address

16020 CARRARA LN
FONTANA CA
92336-4638
US

V. Phone/Fax

Practice location:
  • Phone: 951-534-3227
  • Fax: 302-564-4212
Mailing address:
  • Phone: 951-534-3227
  • Fax: 302-564-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95029794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: