Provider Demographics
NPI:1881036200
Name:BOBADILLA, JULISSA (BA)
Entity Type:Individual
Prefix:MISS
First Name:JULISSA
Middle Name:
Last Name:BOBADILLA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BRANCHFIELD ST APT D4
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5745
Mailing Address - Country:US
Mailing Address - Phone:160-392-1053
Mailing Address - Fax:
Practice Address - Street 1:22 BRANCHFIELD ST APT D4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02124-5745
Practice Address - Country:US
Practice Address - Phone:160-392-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator