Provider Demographics
NPI:1598108219
Name:LOBO, LAILA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAILA
Middle Name:
Last Name:LOBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 E BARNETT RD STE A
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8332
Mailing Address - Country:US
Mailing Address - Phone:541-507-2290
Mailing Address - Fax:541-507-2291
Practice Address - Street 1:625 SW RAMSEY AVE STE A
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5808
Practice Address - Country:US
Practice Address - Phone:541-507-2290
Practice Address - Fax:541-507-2291
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD2160702083X0100X
CAA159450208D00000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program