Healthcare Provider Details

I. General information

NPI: 1386977346
Provider Name (Legal Business Name): OSVALDO LOMELI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BIRMINGHAM DR STE 240A
CARDIFF CA
92007-1757
US

IV. Provider business mailing address

120 BIRMINGHAM DR STE 240A
CARDIFF CA
92007-1757
US

V. Phone/Fax

Practice location:
  • Phone: 858-208-0121
  • Fax:
Mailing address:
  • Phone: 858-208-0121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number69261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: