MEDICARE: SANTIAGO LOMBO LUQUE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	D0106743	MD
3	207R00000X	Internal Medicine Physician	A179239	CA

General Provider Information

NPI Number	:	1174029391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTIAGO LOMBO LUQUE

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	410-933-6423
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 V ST # 2400
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-1460
Country	:	US
Telephone Number	:	916-734-2737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	05/28/2026

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Directions to “ SANTIAGO LOMBO LUQUE ” Practice Location

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