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NPI Code Detail

MEDICARE: MR. NICANOR LUMBRE BOBADILLA I

MEDICARE: MR. NICANOR LUMBRE BOBADILLA I
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
1225100000XPhysical Therapist30258CA

General Provider Information

NPI Number : 1205886975
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NICANOR LUMBRE BOBADILLA I
Provider Business Mailing Address
First Line : 250 N 1ST ST
Second Line : UNIT 511
City : BURBANK
State : CA
Zip : 91502-1826
Country : US
Telephone Number : 818-789-6474
Fax Number :
Provider Business Practice Location Address
First Line : 250 N 1ST ST
Second Line : UNIT 511
City : BURBANK
State : CA
Zip : 91502-1826
Country : US
Telephone Number : 818-789-6474
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 01/04/2012

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Directions to “ MR. NICANOR LUMBRE BOBADILLA I ” Practice Location

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