Healthcare Provider Details

I. General information

NPI: 1851442081
Provider Name (Legal Business Name): AVANEE DHRUV MASTER LOBO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 MIAMI AVE E
VENICE FL
34285-2407
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-261-0088
  • Fax: 941-480-0006
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME93186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: