Provider Demographics
NPI:1649853300
Name:BOBADILLA, YESSICA
Entity type:Individual
Prefix:
First Name:YESSICA
Middle Name:
Last Name:BOBADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11015 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-4601
Mailing Address - Country:US
Mailing Address - Phone:562-906-2676
Mailing Address - Fax:
Practice Address - Street 1:12580 LAKELAND RD
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3940
Practice Address - Country:US
Practice Address - Phone:562-210-5751
Practice Address - Fax:562-202-9102
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2025-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 172V00000X, 373H00000X
CACI39090623101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker