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General NPI Number Information
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NPI Number | 1144094582
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Entity Type | Organization
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Legal Business Name | VICKY LOLO A PROFESSIONAL NURSING CORPORATION
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 2323 BROADWAY
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City | OAKLAND
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State | CA
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Zip | 94612-2414
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Country | US
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Telephone | 415-449-5097
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Fax |
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Provider Business Mailing Address
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Address Line | 2323 BROADWAY
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City | OAKLAND
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State | CA
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Zip | 94612-2414
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Country | US
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Telephone | 415-449-5097
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VICTORIA OMERI
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Credential | APRN
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Telephone | 415-449-5097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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