Provider Demographics
NPI:1184118812
Name:BOBADILLA LEON, RENATO GIANFRANCO (MD)
Entity type:Individual
Prefix:
First Name:RENATO
Middle Name:GIANFRANCO
Last Name:BOBADILLA LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 15TH ST APT 1304
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7697
Mailing Address - Country:US
Mailing Address - Phone:718-500-5994
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:615-372-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-16
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311288207R00000X
PAMD474426207R00000X
390200000X
CAA195959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program