Healthcare Provider Details

I. General information

NPI: 1407744097
Provider Name (Legal Business Name): PAUL JOHN LOMIBAO TESORERO SRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S LOS ROBLES AVE # 501
PASADENA CA
91101-2453
US

IV. Provider business mailing address

1840 S NELSON ST APT 73
WEST COVINA CA
91792-1498
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-3016
  • Fax:
Mailing address:
  • Phone: 956-639-5543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95273267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: