Provider Demographics
NPI:1760681258
Name:BUBALO, JOSIPA (MD)
Entity Type:Individual
Prefix:
First Name:JOSIPA
Middle Name:
Last Name:BUBALO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18396 MILL CT
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-3058
Mailing Address - Country:US
Mailing Address - Phone:707-206-1356
Mailing Address - Fax:
Practice Address - Street 1:3324 CHANATE RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-1708
Practice Address - Country:US
Practice Address - Phone:707-576-4070
Practice Address - Fax:707-576-4087
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program