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General NPI Number Information
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NPI Number | 1467947648
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Entity Type | Organization
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Legal Business Name | BOBINO BRAND LLC
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | 20200 REDWOOD RD STE 8
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-4353
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Country | US
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Telephone | 510-833-1620
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Fax | 510-619-7285
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Provider Business Mailing Address
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Address Line | 1254 107TH AVE
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City | OAKLAND
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State | CA
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Zip | 94603-3822
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Country | US
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Telephone | 510-593-5886
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JAVARTE BOBINO
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Credential | LEP
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Telephone | 510-593-5886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3492
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License Number State | CA
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