Provider Demographics
NPI:1578693842
Name:LOMIBAO, NANCY J (LMFT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:LOMIBAO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 S PACIFIC COAST HWY # 234
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6117
Mailing Address - Country:US
Mailing Address - Phone:310-940-6625
Mailing Address - Fax:
Practice Address - Street 1:109 W TORRANCE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3636
Practice Address - Country:US
Practice Address - Phone:310-376-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36645106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist