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NPI Code Detail

MEDICARE: MANILA BOBBA PA-C

MEDICARE: MANILA BOBBA PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA18190TX

General Provider Information

NPI Number : 1144552431
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANILA BOBBA PA-C
Provider Business Mailing Address
First Line : 1023 LIPSCOMB ST STE 200
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3102
Country : US
Telephone Number : 972-544-6600
Fax Number : 972-544-6604
Provider Business Practice Location Address
First Line : 2111 FORT WORTH HWY
Second Line :
City : WEATHERFORD
State : TX
Zip : 76086-4834
Country : US
Telephone Number : 972-544-6600
Fax Number : 972-544-6604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2010
Last Update Date : 02/27/2026

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Directions to “ MANILA BOBBA PA-C” Practice Location

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