Provider Demographics
NPI:1336249531
Name:LOMITA FAMILY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:LOMITA FAMILY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-465-3121
Mailing Address - Street 1:PO BOX #98
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91946-0098
Mailing Address - Country:US
Mailing Address - Phone:619-465-3121
Mailing Address - Fax:619-465-6708
Practice Address - Street 1:909 CARDIFF ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-5019
Practice Address - Country:US
Practice Address - Phone:619-465-3121
Practice Address - Fax:619-465-6708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1548361587OtherNPI - G. GIL
CA1639270689OtherNPI - SHELDON
CA1639270689OtherNPI - SHELDON