Basic Information
| Provider Information | |||||||||
| NPI: | 1447392022 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOBADILLA | ||||||||
| FirstName: | VICKY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2705 LOMA VISTA RD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930031581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056672801 | ||||||||
| FaxNumber: | 8056672865 | ||||||||
| Practice Location | |||||||||
| Address1: | 168 NORTH BRENT STREET | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052407547 | ||||||||
| FaxNumber: | 8555222245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 12/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 18754 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | RHM08609F | 05 | CA | MEDICAID | ZZT40394F | 05 | CA | MEDICAID | RHM18553H | 05 | CA | MEDICAID | 18754 | 01 | CA | PA LICENSE | OTHER | RHM08608F | 05 | CA | MEDICAID | 95-1683892 | 01 | CA | OTHER INSURANCE | OTHER |