Healthcare Provider Details

I. General information

NPI: 1285844845
Provider Name (Legal Business Name): GRACIELA LOMBARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 MARTIN LUTHER KING JR. BLVD.
LYNWOOD CA
90262
US

IV. Provider business mailing address

1910 W. SUNSET BLVD.
LOS ANGELES CA
90026
US

V. Phone/Fax

Practice location:
  • Phone: 310-638-9025
  • Fax: 310-638-9080
Mailing address:
  • Phone: 213-353-1111
  • Fax: 213-353-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number220800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: