Healthcare Provider Details

I. General information

NPI: 1033507009
Provider Name (Legal Business Name): CLARK LOMBOY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

10601 BEAR HOLLOW DRIVE, BOX 31
RANCHO CORDOVA CA
95670
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7793
  • Fax: 916-561-7566
Mailing address:
  • Phone: 916-854-3879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006613
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number789909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: