Provider Demographics
NPI:1467947648
Name:BOBINO BRAND LLC
Entity Type:Organization
Organization Name:BOBINO BRAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAVARTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBINO
Authorized Official - Suffix:
Authorized Official - Credentials:LEP
Authorized Official - Phone:510-593-5886
Mailing Address - Street 1:1254 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-3822
Mailing Address - Country:US
Mailing Address - Phone:510-593-5886
Mailing Address - Fax:
Practice Address - Street 1:20200 REDWOOD RD STE 8
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4353
Practice Address - Country:US
Practice Address - Phone:510-833-1620
Practice Address - Fax:510-619-7285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3492103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty