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General NPI Number Information
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NPI Number | 1588014500
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Entity Type | Individual
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Provider Name | MR. CARLOS RAMON GONZALEZ BOBADILLA
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Gender | Male
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 08/28/2021
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Provider Practice Location Address
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Address Line | 720 WOOD ST
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City | EUREKA
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State | CA
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Zip | 95501-4413
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Country | US
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Telephone | 707-268-2990
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7182
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City | EUREKA
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State | CA
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Zip | 95502-7182
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Country | US
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Telephone | 707-476-3828
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT112467
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License Number State | CA
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