Healthcare Provider Details

I. General information

NPI: 1861157182
Provider Name (Legal Business Name): GINA LOBITO CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 BLOSSOM HILL RD STE 20
SAN JOSE CA
95123-1188
US

IV. Provider business mailing address

1616 LINCOLN AVE
SAN JOSE CA
95125-3320
US

V. Phone/Fax

Practice location:
  • Phone: 714-504-2439
  • Fax:
Mailing address:
  • Phone: 714-504-2439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number53847
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: