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General NPI Number Information
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NPI Number | 1467599290
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Entity Type | Individual
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Provider Name | JENNIFER S LO PA
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 462 W NAPA ST STE A
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City | SONOMA
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State | CA
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Zip | 95476-6519
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Country | US
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Telephone | 707-935-5600
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Fax | 707-935-5606
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Provider Business Mailing Address
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Address Line | DEPT LA 24687 101
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City | PASADENA
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State | CA
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Zip | 91185-4687
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Country | US
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Telephone | 707-935-5600
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Fax | 707-935-5606
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 15243
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License Number State | CA
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