Provider Demographics
NPI:1770789364
Name:LOBO, KRISTIN (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
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 1:1308 9TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1861
Mailing Address - Country:US
Mailing Address - Phone:415-664-5216
Mailing Address - Fax:
Practice Address - Street 1:1308 9TH ST APT 8
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1861
Practice Address - Country:US
Practice Address - Phone:415-664-5216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043243208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice