Provider Demographics
NPI:1114496551
Name:BOCOBO, RAPHAEL SANTOS (RBT)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:SANTOS
Last Name:BOCOBO
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 ENCHANTED WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3620
Mailing Address - Country:US
Mailing Address - Phone:650-576-4849
Mailing Address - Fax:
Practice Address - Street 1:36 OAK LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2629
Practice Address - Country:US
Practice Address - Phone:650-938-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18-68631106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician