Provider Demographics
NPI:1144552431
Name:BOBBA, MANILA (PA-C)
Entity type:Individual
Prefix:
First Name:MANILA
Middle Name:
Last Name:BOBBA
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 1:3015 HWY 95 STE 105
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-4334
Mailing Address - Country:US
Mailing Address - Phone:928-763-2001
Mailing Address - Fax:928-763-2038
Practice Address - Street 1:3015 HIGHWAY 95
Practice Address - Street 2:SUITE 105
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-4334
Practice Address - Country:US
Practice Address - Phone:928-763-2001
Practice Address - Fax:928-763-2038
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4576363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant