Provider Demographics
NPI:1427055706
Name:LO, FERNANDINA F (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDINA
Middle Name:F
Last Name:LO
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 1:5720 STONERIDGE MALL RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2828
Mailing Address - Country:US
Mailing Address - Phone:925-737-0307
Mailing Address - Fax:925-463-3979
Practice Address - Street 1:5720 STONERIDGE MALL RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2828
Practice Address - Country:US
Practice Address - Phone:925-737-0307
Practice Address - Fax:925-463-3979
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2009-11-24
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
CAA51604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A516040Medicaid
CA00A516040Medicaid
00A516040Medicare PIN