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General NPI Number Information
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NPI Number | 1992853543
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Entity Type | Organization
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Legal Business Name | MANJULA BOBBALA M.D.,INC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1600 CREEKSIDE DR SUITE # 3700
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City | FOLSOM
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State | CA
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Zip | 95630-3444
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Country | US
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Telephone | 916-901-1455
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Fax |
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Provider Business Mailing Address
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Address Line | 2169 SEBASTIAN WAY
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City | ROSEVILLE
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State | CA
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Zip | 95661-3214
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Country | US
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Telephone | 916-218-5618
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MANJULA BOBBALA
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Credential | M.D
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Telephone | 916-218-5618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A 87444
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License Number State |
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