Provider Demographics
NPI:1144564709
Name:LOMELI, LUIS ALBERTO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:LOMELI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALBERT
Other - Middle Name:
Other - Last Name:LOMELI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5201 GREAT AMERICA PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1140
Mailing Address - Country:US
Mailing Address - Phone:323-205-7088
Mailing Address - Fax:833-419-0181
Practice Address - Street 1:5201 GREAT AMERICA PKWY STE 320
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1140
Practice Address - Country:US
Practice Address - Phone:323-205-7088
Practice Address - Fax:833-419-0181
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143022106H00000X
390200000X
CA125768106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program