Provider Demographics
NPI:1538643051
Name:LOMELI, SERAFIN JR (PPS CREDENTIAL)
Entity Type:Individual
Prefix:MR
First Name:SERAFIN
Middle Name:
Last Name:LOMELI
Suffix:JR
Gender:M
Credentials:PPS CREDENTIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S DE ANZA BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391-7900
Mailing Address - Country:US
Mailing Address - Phone:209-839-7400
Mailing Address - Fax:
Practice Address - Street 1:111 S DE ANZA BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOUSE
Practice Address - State:CA
Practice Address - Zip Code:95391-7900
Practice Address - Country:US
Practice Address - Phone:209-836-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180132030103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool