Provider Demographics
NPI:1811136344
Name:BOBULA, ANGEL M (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:M
Last Name:BOBULA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 FIFTH ST. NE
Mailing Address - Street 2:AMBULATORY CARE
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203
Mailing Address - Country:US
Mailing Address - Phone:330-615-3911
Mailing Address - Fax:330-615-4063
Practice Address - Street 1:155 5TH ST NE
Practice Address - Street 2:AMBULATORY CARE
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3332
Practice Address - Country:US
Practice Address - Phone:330-615-3911
Practice Address - Fax:330-615-4063
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5437133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered