Healthcare Provider Details

I. General information

NPI: 1912137225
Provider Name (Legal Business Name): LOMISA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9951 ATLANTIC BLVD , SUITE 109
JACKSONVILLE FL
32225-6558
US

IV. Provider business mailing address

9951 ATLANTIC BLVD , SUITE 109
JACKSONVILLE FL
32225-6558
US

V. Phone/Fax

Practice location:
  • Phone: 904-723-3008
  • Fax: 904-723-3010
Mailing address:
  • Phone: 904-723-3008
  • Fax: 904-723-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERTO DIAZ
Title or Position: VICEPRESIDENT
Credential:
Phone: 904-723-3008