Healthcare Provider Details

I. General information

NPI: 1528242153
Provider Name (Legal Business Name): LOMBARD MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 E ORANGE GROVE BLVD
PASADENA CA
91104-3039
US

IV. Provider business mailing address

128 CARR DR 3
GLENDALE CA
91205-1548
US

V. Phone/Fax

Practice location:
  • Phone: 626-254-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: