Provider Demographics
NPI:1609133883
Name:LOMIBAO, JOSEPHUS CADAOAS
Entity Type:Individual
Prefix:MR
First Name:JOSEPHUS
Middle Name:CADAOAS
Last Name:LOMIBAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9329 ARROWHEAD BLUFF AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0191
Mailing Address - Country:US
Mailing Address - Phone:702-544-5119
Mailing Address - Fax:
Practice Address - Street 1:2520 SAINT ROSE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7783
Practice Address - Country:US
Practice Address - Phone:702-778-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health