Provider Demographics
NPI:1720576622
Name:LOBBAN, ROSE CHARLENE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:CHARLENE
Last Name:LOBBAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:CHARLENE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1841 NW 125TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2552
Mailing Address - Country:US
Mailing Address - Phone:954-274-5934
Mailing Address - Fax:786-926-2912
Practice Address - Street 1:6071 NW 198TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4857
Practice Address - Country:US
Practice Address - Phone:954-274-5934
Practice Address - Fax:786-926-2912
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD1600X
FL11-1268-GH261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities