Healthcare Provider Details

I. General information

NPI: 1285644492
Provider Name (Legal Business Name): JEANNETTE D LOBAO PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1797 FOURTH ST
LIVERMORE CA
94550-4347
US

IV. Provider business mailing address

1797 FOURTH ST
LIVERMORE CA
94550-4347
US

V. Phone/Fax

Practice location:
  • Phone: 925-443-2500
  • Fax: 925-443-0771
Mailing address:
  • Phone: 925-443-2500
  • Fax: 925-443-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY17419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: