Provider Demographics
NPI:1497451157
Name:BOBBITT, LILLIAN JUNE CASINO (NP)
Entity Type:Individual
Prefix:
First Name:LILLIAN JUNE
Middle Name:CASINO
Last Name:BOBBITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:206 S LUCIA AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3770
Mailing Address - Country:US
Mailing Address - Phone:323-533-4113
Mailing Address - Fax:
Practice Address - Street 1:23211 HAWTHORNE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3769
Practice Address - Country:US
Practice Address - Phone:424-247-4962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023621363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner