Provider Demographics
NPI:1275841876
Name:BOHBOT, LINE (PA-C)
Entity Type:Individual
Prefix:
First Name:LINE
Middle Name:
Last Name:BOHBOT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINE
Other - Middle Name:
Other - Last Name:BOHBOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:4308 ALTON RD
Mailing Address - Street 2:SUITE 880
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4556
Mailing Address - Country:US
Mailing Address - Phone:305-674-8038
Mailing Address - Fax:305-674-8192
Practice Address - Street 1:4308 ALTON RD
Practice Address - Street 2:SUITE 880
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4556
Practice Address - Country:US
Practice Address - Phone:305-674-8038
Practice Address - Fax:305-674-8192
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant