MEDICARE: LOMA HEALTH CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1245537455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOMA HEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	8989 WESTHEIMER RD
Second Line	:	SUITE 232
City	:	HOUSTON
State	:	TX
Zip	:	77063-3621
Country	:	US
Telephone Number	:	713-785-0747
Fax Number	:	713-785-0750

Provider Business Practice Location Address
First Line	:	8989 WESTHEIMER RD
Second Line	:	SUITE 232
City	:	HOUSTON
State	:	TX
Zip	:	77063-3621
Country	:	US
Telephone Number	:	713-785-0747
Fax Number	:	713-785-0750

Authorized Official
Title or Position	:	OWNER
Name	:	MR. VASILY LOMANOV
Credential	:
Telephone Number	:	713-785-0747

Provider Enumeration Date	:	02/24/2011
Last Update Date	:	02/24/2011

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Directions to “LOMA HEALTH CENTER LLC ” Practice Location

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