Provider Demographics
NPI:1255185062
Name:BOBILA, JUSTIN (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:BOBILA
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35845 TREVINO TRL
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-6232
Mailing Address - Country:US
Mailing Address - Phone:951-534-3227
Mailing Address - Fax:
Practice Address - Street 1:15434 W SAGE ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-9751
Practice Address - Country:US
Practice Address - Phone:760-843-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029794363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health