Provider Demographics
NPI:1336565480
Name:CHRISTIAN BOCOBO M.D. PROFESSIONAL
Entity Type:Organization
Organization Name:CHRISTIAN BOCOBO M.D. PROFESSIONAL
Other - Org Name:MUSCULOSKELETAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:REYES
Authorized Official - Last Name:BOCOBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-755-3745
Mailing Address - Street 1:1850 SULLIVAN AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2221
Mailing Address - Country:US
Mailing Address - Phone:650-755-3745
Mailing Address - Fax:650-755-3883
Practice Address - Street 1:1850 SULLIVAN AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2221
Practice Address - Country:US
Practice Address - Phone:650-755-3745
Practice Address - Fax:650-755-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A45427261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A454271Medicare PIN