Healthcare Provider Details

I. General information

NPI: 1346226057
Provider Name (Legal Business Name): ANDREW K LOBE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S SUNRISE WAY SUITE 300
PALM SPRINGS CA
92262-0118
US

IV. Provider business mailing address

72780 COUNTRY CLUB DR BLDG B 203
RANCHO MIRAGE CA
92270-4126
US

V. Phone/Fax

Practice location:
  • Phone: 760-969-7780
  • Fax:
Mailing address:
  • Phone: 760-674-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1060527
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: