Provider Demographics
NPI:1376186627
Name:BOBBITI, DENISE JACQUELINE (FNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:JACQUELINE
Last Name:BOBBITI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:JACQUELINE
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13514 PARK CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-2265
Mailing Address - Country:US
Mailing Address - Phone:626-827-4614
Mailing Address - Fax:
Practice Address - Street 1:301 W HUNTINGTON DR STE 327
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-1501
Practice Address - Country:US
Practice Address - Phone:626-447-8129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily