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General NPI Number Information
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NPI Number | 1902466659
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Entity Type | Individual
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Provider Name | BOBBY SINSONGSERM
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Gender | Male
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Dates
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Enumeration Date | 06/15/2019
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 483 W SEED FARM RD
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City | SACATON
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State | AZ
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Zip | 85147-5000
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Country | US
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Telephone | 520-562-3321
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Fax |
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Provider Business Mailing Address
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Address Line | 13724 EL ESPEJO RD
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City | LA MIRADA
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State | CA
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Zip | 90638-3718
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Country | US
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Telephone | 562-447-6307
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT-002365
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License Number State | AZ
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