MEDICARE: OSVALDO LOMELI LCSW

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	1041C0700X	Clinical Social Worker	69261	CA

General Provider Information

NPI Number	:	1386977346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSVALDO LOMELI LCSW

Provider Business Mailing Address
First Line	:	120 BIRMINGHAM DR STE 240A
Second Line	:
City	:	CARDIFF
State	:	CA
Zip	:	92007-1757
Country	:	US
Telephone Number	:	858-208-0121
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 BIRMINGHAM DR STE 240A
Second Line	:
City	:	CARDIFF
State	:	CA
Zip	:	92007-1757
Country	:	US
Telephone Number	:	858-208-0121
Fax Number	:

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

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	09/15/2022

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