Provider Demographics
NPI:1891419388
Name:LOMELI, SOFIA (NURSE)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:LOMELI
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14332 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1944
Mailing Address - Country:US
Mailing Address - Phone:818-989-1996
Mailing Address - Fax:818-543-6767
Practice Address - Street 1:14332 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1944
Practice Address - Country:US
Practice Address - Phone:818-989-1996
Practice Address - Fax:818-543-6767
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA682358164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse