Provider Demographics
NPI:1457480386
Name:LOBOS, PRINCESS LEIA (MSW INTERN)
Entity Type:Individual
Prefix:MISS
First Name:PRINCESS
Middle Name:LEIA
Last Name:LOBOS
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12342 CONCORD CT
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2147
Mailing Address - Country:US
Mailing Address - Phone:951-237-9646
Mailing Address - Fax:
Practice Address - Street 1:1350 3RD ST
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-5201
Practice Address - Country:US
Practice Address - Phone:909-596-5921
Practice Address - Fax:909-596-3954
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor