Provider Demographics
NPI:1922551340
Name:LOMIBAO, LOUIE
Entity Type:Individual
Prefix:
First Name:LOUIE
Middle Name:
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 1:9262 LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3586
Mailing Address - Country:US
Mailing Address - Phone:916-897-4772
Mailing Address - Fax:
Practice Address - Street 1:9262 LOUIS ST
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-3586
Practice Address - Country:US
Practice Address - Phone:916-897-4772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator