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General NPI Number Information
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NPI Number | 1144552431
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Entity Type | Individual
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Provider Name | MANILA BOBBA PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/11/2010
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 3015 HIGHWAY 95 SUITE 105
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-4334
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Country | US
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Telephone | 928-763-2001
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Fax | 928-763-2038
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Provider Business Mailing Address
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Address Line | 3015 HWY 95 STE 105
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-4334
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Country | US
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Telephone | 928-763-2001
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Fax | 928-763-2038
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4576
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License Number State | AZ
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