Provider Demographics
NPI:1699071464
Name:LOBO, CLARA LUCIA (NP)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:LUCIA
Last Name:LOBO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 HARVEST HILL RD STE 182
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1605
Mailing Address - Country:US
Mailing Address - Phone:972-484-0040
Mailing Address - Fax:
Practice Address - Street 1:5440 HARVEST HILL RD STE 182
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1605
Practice Address - Country:US
Practice Address - Phone:972-484-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX656865363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB148538Medicare PIN