Provider Demographics
NPI:1952654824
Name:LOBATO, JIM L (PHARMD)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:L
Last Name:LOBATO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 LORING ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1909
Mailing Address - Country:US
Mailing Address - Phone:858-488-0535
Mailing Address - Fax:
Practice Address - Street 1:2687 GATEWAY RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-1726
Practice Address - Country:US
Practice Address - Phone:760-929-7912
Practice Address - Fax:760-929-7916
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44973183500000X
AZS009843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist