Healthcare Provider Details

I. General information

NPI: 1336249531
Provider Name (Legal Business Name): LOMITA FAMILY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 CARDIFF ST
SAN DIEGO CA
92114-5019
US

IV. Provider business mailing address

PO BOX #98
LEMON GROVE CA
91946-0098
US

V. Phone/Fax

Practice location:
  • Phone: 619-465-3121
  • Fax: 619-465-6708
Mailing address:
  • Phone: 619-465-3121
  • Fax: 619-465-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL GIL
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 619-465-3121