Provider Demographics
NPI:1447212428
Name:BOCOBO, CHRISTIAN REYES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:REYES
Last Name:BOCOBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 SULLIVAN AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2221
Mailing Address - Country:US
Mailing Address - Phone:650-755-3745
Mailing Address - Fax:650-755-3883
Practice Address - Street 1:1850 SULLIVAN AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2221
Practice Address - Country:US
Practice Address - Phone:650-755-3745
Practice Address - Fax:650-755-3883
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45427208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A454270Medicare UPIN
CA00A454271Medicare ID - Type UnspecifiedSAN MATEO CLINIC LOCATION
CA00A454272Medicare ID - Type UnspecifiedDALY CITY CLINIC LOCATION
CAC54570Medicare UPIN