Provider Demographics
NPI:1285644492
Name:LOBAO, JEANNETTE D (PSYD)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:D
Last Name:LOBAO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1797 FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4347
Mailing Address - Country:US
Mailing Address - Phone:925-443-2500
Mailing Address - Fax:925-443-0771
Practice Address - Street 1:1797 FOURTH ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4347
Practice Address - Country:US
Practice Address - Phone:925-443-2500
Practice Address - Fax:925-443-0771
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17419103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ77050ZMedicare Oscar/Certification