Provider Demographics
NPI:1992853543
Name:MANJULA BOBBALA M.D.,INC
Entity Type:Organization
Organization Name:MANJULA BOBBALA M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MANJULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBBALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-218-5618
Mailing Address - Street 1:2169 SEBASTIAN WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3214
Mailing Address - Country:US
Mailing Address - Phone:916-218-5618
Mailing Address - Fax:
Practice Address - Street 1:1600 CREEKSIDE DR
Practice Address - Street 2:SUITE # 3700
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3444
Practice Address - Country:US
Practice Address - Phone:916-901-1455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A 87444261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care