Provider Demographics
NPI:1790541555
Name:LOFRANCO, MARY ROSE
Entity Type:Individual
Prefix:
First Name:MARY ROSE
Middle Name:
Last Name:LOFRANCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHIANTI CIR
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-3520
Mailing Address - Country:US
Mailing Address - Phone:559-367-9446
Mailing Address - Fax:
Practice Address - Street 1:222 COALINGA PLZ
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-1702
Practice Address - Country:US
Practice Address - Phone:559-935-5555
Practice Address - Fax:559-935-2827
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029231363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health