Provider Demographics
NPI:1982057071
Name:BOBADILL, CONRADO ESTEBAN
Entity Type:Individual
Prefix:MR
First Name:CONRADO
Middle Name:ESTEBAN
Last Name:BOBADILL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CONRADO
Other - Middle Name:ESTEBAN
Other - Last Name:BOBADILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:200 SOMBRA VERDE
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-8512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 SOMBRA VERDE
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-8512
Practice Address - Country:US
Practice Address - Phone:575-805-4234
Practice Address - Fax:575-882-1095
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker