Provider Demographics
NPI:1013938620
Name:LOMBILLO, VIVIAN A (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:A
Last Name:LOMBILLO
Suffix:
Gender:F
Credentials:MD PHD
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Mailing Address - Street 1:703 LILLY RD NE SUITE 105
Mailing Address - Street 2:NORTHWEST PEDIATRIC DERMATOLOGY, PLLC
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-539-6141
Mailing Address - Fax:
Practice Address - Street 1:703 LILLY RD NE SUITE 105
Practice Address - Street 2:NORTHWEST PEDIATRIC DERMATOLOGY, PLLC
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-539-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00046225207NP0225X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA03367104Medicaid
WA03367104Medicaid