Healthcare Provider Details

I. General information

NPI: 1013165828
Provider Name (Legal Business Name): NEREIDA LOMELI MFT-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 TULLY RD STE F
MODESTO CA
95350-2946
US

IV. Provider business mailing address

1800 TULLY RD STE F
MODESTO CA
95350-2946
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-1750
  • Fax: 209-576-1768
Mailing address:
  • Phone: 209-576-1750
  • Fax: 209-576-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number54626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: