Provider Demographics
NPI:1568969301
Name:LOMELI, ROSALINA
Entity Type:Individual
Prefix:
First Name:ROSALINA
Middle Name:
Last Name:LOMELI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 E 3RD ST STE C
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1630
Mailing Address - Country:US
Mailing Address - Phone:213-620-5712
Mailing Address - Fax:
Practice Address - Street 1:470 E 3RD ST STE C
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1630
Practice Address - Country:US
Practice Address - Phone:213-620-5712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA740447164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program