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General NPI Number Information
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NPI Number | 1760453922
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Entity Type | Organization
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Legal Business Name | LARRY J LO MD INC
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 632 W 11TH ST SUITE 119
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City | TRACY
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State | CA
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Zip | 95376-3856
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Country | US
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Telephone | 209-229-3700
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Fax | 209-229-3755
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Provider Business Mailing Address
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Address Line | 632 W 11TH ST SUITE 119
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City | TRACY
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State | CA
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Zip | 95376-3856
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Country | US
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Telephone | 209-229-3700
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Fax | 209-229-3755
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Authorized Official
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Title or Position | MD
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Name | MR. LARRY J LO
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Credential | MD
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Telephone | 209-229-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G54156
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License Number State | CA
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