Healthcare Provider Details

I. General information

NPI: 1982057071
Provider Name (Legal Business Name): MR. CONRADO ESTEBAN BOBADILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CONRADO ESTEBAN BOBADILL LMSW

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOMBRA VERDE
ANTHONY NM
88021-8512
US

IV. Provider business mailing address

200 SOMBRA VERDE
ANTHONY NM
88021-8512
US

V. Phone/Fax

Practice location:
  • Phone: 575-805-4234
  • Fax: 575-882-1095
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: