Provider Demographics
NPI:1205886975
Name:BOBADILLA, NICANOR LUMBRE I
Entity type:Individual
Prefix:MR
First Name:NICANOR
Middle Name:LUMBRE
Last Name:BOBADILLA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N 1ST ST
Mailing Address - Street 2:UNIT 511
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1826
Mailing Address - Country:US
Mailing Address - Phone:818-789-6474
Mailing Address - Fax:
Practice Address - Street 1:250 N 1ST ST
Practice Address - Street 2:UNIT 511
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1826
Practice Address - Country:US
Practice Address - Phone:818-789-6474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist