Provider Demographics
NPI:1508277070
Name:LOBO, MAVIS (SAC,)
Entity Type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:LOBO
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Gender:F
Credentials:SAC,
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Mailing Address - Street 1:1673 S FLANDERS WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5509
Mailing Address - Country:US
Mailing Address - Phone:720-748-2888
Mailing Address - Fax:
Practice Address - Street 1:1673 S FLANDERS WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-5509
Practice Address - Country:US
Practice Address - Phone:720-748-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-18
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical