Provider Demographics
NPI:1578692927
Name:LOMBANA, PAMELA ELISA (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELISA
Last Name:LOMBANA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 RIDGELEY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6728
Mailing Address - Country:US
Mailing Address - Phone:713-467-4900
Mailing Address - Fax:
Practice Address - Street 1:2323 WIRT RD
Practice Address - Street 2:SUITE F 8
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-1232
Practice Address - Country:US
Practice Address - Phone:713-467-4900
Practice Address - Fax:713-467-6006
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX535877363LP2300X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186523001Medicaid
TX01245176OtherAMERIGROUP
TX186523003OtherTX HEALTHSTEPS EPDST
TX260699437OtherTAX ID