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General NPI Number Information
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NPI Number | 1932401601
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Entity Type | Organization
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Legal Business Name | FERNANDINA G LO MD INC
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 5720 STONERIDGE MALL RD STE 270
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City | PLEASANTON
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State | CA
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Zip | 94588-2854
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Country | US
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Telephone | 925-737-0307
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Fax | 925-463-3979
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Provider Business Mailing Address
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Address Line | 5720 STONERIDGE MALL RD STE 270
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City | PLEASANTON
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State | CA
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Zip | 94588-2854
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Country | US
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Telephone | 925-737-0307
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Fax | 925-463-3979
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FERNANDINA G LO
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Credential | M.D.
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Telephone | 925-737-0307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A51604
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License Number State | CA
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