Provider Demographics
NPI:1447392022
Name:BOBADILLA, VICKY (PA-C)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:BOBADILLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 LOMA VISTA RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1581
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:168 NORTH BRENT STREET
Practice Address - Street 2:SUITE 404
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-240-7547
Practice Address - Fax:855-522-2245
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18754363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08609FMedicaid
CAZZT40394FMedicaid
CARHM18553HMedicaid
CA18754OtherPA LICENSE
CARHM08608FMedicaid
CA95-1683892OtherOTHER INSURANCE