Healthcare Provider Details

I. General information

NPI: 1013605575
Provider Name (Legal Business Name): JOLENE JESSICA LOBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 STONECIPHER DR
ADA OK
74820-3439
US

IV. Provider business mailing address

1400 FLORIDA AVE STE 102
MODESTO CA
95350-4446
US

V. Phone/Fax

Practice location:
  • Phone: 800-851-9136
  • Fax:
Mailing address:
  • Phone: 505-417-2579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA206710
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA206710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: