Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1003279605 |
---|---|
Provider Name | Brenda Bobadilla |
First Address | West Covina, CA 91791-2510 |
Second Address | El Monte, CA 91731-2830 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2016 |
Last Update Date | 14/09/2016 |