Provider Demographics
NPI:1467217588
Name:LOMIBAO PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:LOMIBAO PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MADALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMIBAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-509-1415
Mailing Address - Street 1:PO BOX 582602
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-0044
Mailing Address - Country:US
Mailing Address - Phone:916-509-1415
Mailing Address - Fax:916-273-9757
Practice Address - Street 1:8788 ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1766
Practice Address - Country:US
Practice Address - Phone:916-509-1415
Practice Address - Fax:916-273-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty