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NPI Code Detail

MEDICARE: DR. JENNY LISA LOBO M.D.

MEDICARE: DR. JENNY LISA LOBO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianMD00048114WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1US9380059OTHERWAAETNA PCP PIN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
33979VEOTHERWABLUE SHIELD #

General Provider Information

NPI Number : 1124211388
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNY LISA LOBO M.D.
Provider Business Mailing Address
First Line : 7600 EVERGREEN WAY
Second Line :
City : EVERETT
State : WA
Zip : 98203-6421
Country : US
Telephone Number : 206-860-5414
Fax Number :
Provider Business Practice Location Address
First Line : 904 7TH AVE
Second Line :
City : SEATTLE
State : WA
Zip : 98104-1132
Country : US
Telephone Number : 206-329-1760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2007
Last Update Date : 05/14/2026

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