Provider Demographics
NPI:1780475129
Name:FOBB, DORLISA
Entity type:Individual
Prefix:
First Name:DORLISA
Middle Name:
Last Name:FOBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6929 COMMERCE CIR APT 7311
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1891
Mailing Address - Country:US
Mailing Address - Phone:337-322-0079
Mailing Address - Fax:
Practice Address - Street 1:1058 E WORTHY ST STE B-2
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4359
Practice Address - Country:US
Practice Address - Phone:225-450-3216
Practice Address - Fax:225-450-3799
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator