Provider Demographics
NPI:1588711709
Name:LOBO, CAROLYN MARY (MD,)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:MARY
Last Name:LOBO
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:M
Other - Last Name:LOBO,MD,INC.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5068
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91221-2068
Mailing Address - Country:US
Mailing Address - Phone:818-242-3333
Mailing Address - Fax:818-552-2722
Practice Address - Street 1:1430 TARA HILLS DR
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2580
Practice Address - Country:US
Practice Address - Phone:510-724-3768
Practice Address - Fax:435-578-7062
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63239208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A632390Medicaid
CAG62170Medicare UPIN
CA00A632390Medicaid