Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO182451 | OR |
NPI | 1336549179 |
---|---|
Provider Name | Anna Lobzova |
First Address | Bronx, NY 10457-2545 |
Second Address | Corvallis, OR 97330-4714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2014 |
Last Update Date | 26/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500746388 | (05) | OR |