Provider Demographics
NPI:1235357450
Name:CAROLYN M. LOBO, M.D., INC.
Entity Type:Organization
Organization Name:CAROLYN M. LOBO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:510-724-3768
Mailing Address - Street 1:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-0864
Mailing Address - Country:US
Mailing Address - Phone:510-724-3768
Mailing Address - Fax:435-578-7062
Practice Address - Street 1:1430 TARA HILLS DR
Practice Address - Street 2:SUITE A
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2580
Practice Address - Country:US
Practice Address - Phone:510-724-3768
Practice Address - Fax:435-578-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63239208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A632390Medicaid
1588711709OtherNPI -ENTITY 1
00A632390Medicare ID - Type UnspecifiedMEDICARE
CA00A632390Medicaid