Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D7083 | AZ |
NPI | 1003008814 |
---|---|
Provider Name | Dr. Marilyn Lobo |
First Address | Litchfield Park, AZ 85340-4901 |
Second Address | Litchfield Park, AZ 85340-4901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2007 |
Last Update Date | 15/08/2007 |