Provider Demographics
NPI:1659562379
Name:LOMBA, BRADFORD DOUGLAS (SFIDC)
Entity Type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:DOUGLAS
Last Name:LOMBA
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL DEPARTMENT
Mailing Address - Street 2:USS INGRAHAM FFG-61
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96668 1515
Mailing Address - Country:US
Mailing Address - Phone:425-304-5692
Mailing Address - Fax:425-304-5221
Practice Address - Street 1:MEDICAL DEPARTMENT
Practice Address - Street 2:USS INGRAHAM FFG-61
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96668 1515
Practice Address - Country:US
Practice Address - Phone:425-304-5692
Practice Address - Fax:425-304-5221
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman