=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184748592
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVA ANJELINA LOMELI LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 10/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1524 MCHENRY AVE STE 450
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-4574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-557-6225
-----------------------------------------------------
Fax | 209-557-9032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1225 OAKDALE RD VA PALO ALTO HEALTH CARE SYSTEM
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95355-3357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-557-6225
-----------------------------------------------------
Fax | 209-557-9032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 23504
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------