Provider Demographics
NPI:1104842038
Name:BOMBINO, PAUL AMADEO (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:AMADEO
Last Name:BOMBINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13907 W CAMINO DEL SOL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4405
Mailing Address - Country:US
Mailing Address - Phone:623-584-4695
Mailing Address - Fax:623-298-6708
Practice Address - Street 1:13907 W CAMINO DEL SOL
Practice Address - Street 2:SUITE 101
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4405
Practice Address - Country:US
Practice Address - Phone:623-584-4695
Practice Address - Fax:623-298-6708
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25469174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z3916OtherHEALTHNET AZ
AZ340013728OtherRAILROAD MEDICARE
AZAZ0810320OtherBLUE CROSS BLUE SHIELD AZ
AZ397051Medicaid
AZWMBDD03Medicare ID - Type Unspecified
AZ397051Medicaid