Provider Demographics
NPI:1053688689
Name:STORRIE-LOMBARDI, MICHAEL CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CARL
Last Name:STORRIE-LOMBARDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 N MAR VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-4617
Mailing Address - Country:US
Mailing Address - Phone:626-791-4206
Mailing Address - Fax:
Practice Address - Street 1:798 N MAR VISTA AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-4617
Practice Address - Country:US
Practice Address - Phone:626-791-4206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 138712084P0800X
CACFE 348152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACFE 34815OtherMEDICAL BOARD OF CALIFORNIA
WAMD 00013871OtherWASHINGTON STATE DEPARTMENT OF HEALTH
WAMD 00013871OtherWASHINGTON STATE DEPARTMENT OF HEALTH