MEDICARE: ROBERT LOMBARDI BS

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	225800000X	Recreation Therapist	80281	CA

General Provider Information

NPI Number	:	1730762469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT LOMBARDI BS

Provider Business Mailing Address
First Line	:	1968 RIDGE WATER DR
Second Line	:
City	:	SUTHERLIN
State	:	OR
Zip	:	97479-9735
Country	:	US
Telephone Number	:	530-566-7543
Fax Number	:

Provider Business Practice Location Address
First Line	:	1968 RIDGE WATER DR
Second Line	:
City	:	SUTHERLIN
State	:	OR
Zip	:	97479-9735
Country	:	US
Telephone Number	:	530-566-7543
Fax Number	:

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

Provider Enumeration Date	:	04/30/2021
Last Update Date	:	04/30/2021

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