Provider Information for 1912483983
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KATRINA MARY BOBO IMFT 97106, PCCI 354
Other Names:Other Name:KATRINA MARY SPRAGGINSSex: Female
NPI: 1912483983
Last Updated: 2024-07-24
Certification Date: 2024-07-24
Certification Date: 2024-07-24
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1912483983 | ||||||||||||
| Enumeration Date | 2018-07-12 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 521 BAILEY LOOP RD GARDENDALE, AL 35071-3212 United States Phone: 205-422-0484 | Fax: | ||||||||||||
| Primary Practice Address | 5201 GREAT AMERICA PKWY STE 320 SANTA CLARA, CA 95054-1140 United States Phone: 323-205-7088 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 1375 55TH ST 390 40TH ST | ||||||||||||
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