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General NPI Number Information
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NPI Number | 1033507009
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Entity Type | Individual
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Provider Name | CLARK LOMBOY NP
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Gender | Male
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 5342 DUDLEY BLVD
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City | MCCLELLAN
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State | CA
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Zip | 95652-1012
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Country | US
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Telephone | 916-561-7793
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Fax | 916-561-7566
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Provider Business Mailing Address
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Address Line | 10601 BEAR HOLLOW DRIVE, BOX 31
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670
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Country | US
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Telephone | 916-854-3879
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95006613
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 789909
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License Number State | CA
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