Provider Demographics
NPI:1760742498
Name:LOTFI, JUSTIN BOBACK (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:BOBACK
Last Name:LOTFI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3500 ALAMEDA DE LAS PULGAS STE 200
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6569
Mailing Address - Country:US
Mailing Address - Phone:650-815-9577
Mailing Address - Fax:650-289-0166
Practice Address - Street 1:3500 ALAMEDA DE LAS PULGAS STE 200
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6569
Practice Address - Country:US
Practice Address - Phone:650-815-9577
Practice Address - Fax:650-289-0166
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine