Provider Demographics
NPI:1114426319
Name:HOM, CALVIN MITCHELL BOBBITT (ATC, LAT, PES)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:MITCHELL BOBBITT
Last Name:HOM
Suffix:
Gender:M
Credentials:ATC, LAT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25909 MORENO DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92521-2112
Practice Address - Country:US
Practice Address - Phone:661-755-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-03
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT92062255A2300X
KYTCA9722255A2300X
KYAT19312255A2300X
CA390200000X, 2255A2300X
OK11632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program