Provider Demographics
NPI:1134230386
Name:BOBBA, ANNA (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BOBBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8030
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:1551 BISHOP ST STE B260
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4635
Practice Address - Country:US
Practice Address - Phone:805-549-0402
Practice Address - Fax:805-549-0465
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116639207V00000X
CA158209207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116639Medicaid
IL1635377OtherBLUE CROSS/BLUE SHIELD
IL1635377OtherBLUE CROSS/BLUE SHIELD