=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962367763
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. NICHOLAS ROBERT LOMBARDO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2025
-----------------------------------------------------
Last Update Date | 12/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10738 RIVERSIDE DR STE A
-----------------------------------------------------
City | TOLUCA LAKE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91602-2372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-766-4307
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2326 2ND ST APT 3
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90405-3422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-766-4307
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC37514
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------