Provider Demographics
NPI:1932401601
Name:FERNANDINA G LO MD INC
Entity Type:Organization
Organization Name:FERNANDINA G LO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-737-0307
Mailing Address - Street 1:5720 STONERIDGE MALL RD STE 270
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2854
Mailing Address - Country:US
Mailing Address - Phone:925-737-0307
Mailing Address - Fax:925-463-3979
Practice Address - Street 1:5720 STONERIDGE MALL RD STE 270
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2854
Practice Address - Country:US
Practice Address - Phone:925-737-0307
Practice Address - Fax:925-463-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF95028Medicare UPIN