Healthcare Provider Details

I. General information

NPI: 1073426060
Provider Name (Legal Business Name): LOMBA MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 US HIGHWAY 92 W
AUBURNDALE FL
33823
US

IV. Provider business mailing address

PO BOX 742291
ATLANTA GA
30374-2291
US

V. Phone/Fax

Practice location:
  • Phone: 941-766-4267
  • Fax:
Mailing address:
  • Phone: 941-766-4267
  • Fax: 941-766-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: FERNANDO LUIS LOMBA
Title or Position: PRESIDENT
Credential:
Phone: 941-766-4120