Healthcare Provider Details

I. General information

NPI: 1699931253
Provider Name (Legal Business Name): JAIME LYN LONGOBARDI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 10/17/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS NEW ORLEANS UNIT 100207 #1
FPO AP
96673-0700
US

IV. Provider business mailing address

UNIT 100207 BOX 1
FPO AP
96673-0700
US

V. Phone/Fax

Practice location:
  • Phone: 808-653-2191
  • Fax:
Mailing address:
  • Phone: 808-653-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102202484
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: