Provider Demographics
NPI:1184638686
Name:BOBBA, VISHNU V (MD)
Entity Type:Individual
Prefix:
First Name:VISHNU
Middle Name:V
Last Name:BOBBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VISHNU
Other - Middle Name:VARDHANA RAO
Other - Last Name:BOBBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2615 EAST CLINTON AVENUE
Mailing Address - Street 2:VA CENTRAL CALIFORNIA HEALTHCARE SYSTEM
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-2223
Mailing Address - Country:US
Mailing Address - Phone:559-228-5311
Mailing Address - Fax:559-228-6952
Practice Address - Street 1:2615 EAST CLINTON AVENUE
Practice Address - Street 2:VA CENTRAL CALIFORNIA HEALTHCARE SYSTEM
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-2223
Practice Address - Country:US
Practice Address - Phone:559-228-5311
Practice Address - Fax:559-228-6952
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40046207UN0903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0903XAllopathic & Osteopathic PhysiciansNuclear MedicineIn Vivo & In Vitro Nuclear Medicine