Provider Demographics
NPI:1891975199
Name:BOBADILLA, MAYRA L (PA-C)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:L
Last Name:BOBADILLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 EXPOSITION BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-5196
Mailing Address - Country:US
Mailing Address - Phone:916-297-6257
Mailing Address - Fax:
Practice Address - Street 1:1565 EXPOSITION BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-5196
Practice Address - Country:US
Practice Address - Phone:916-297-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant