Provider Demographics
NPI:1932566692
Name:LOMELI, MONIQUE I
Entity Type:Individual
Prefix:MISS
First Name:MONIQUE
Middle Name:
Last Name:LOMELI
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 DUARTE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3567
Mailing Address - Country:US
Mailing Address - Phone:702-613-2656
Mailing Address - Fax:
Practice Address - Street 1:1692 DUARTE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-3567
Practice Address - Country:US
Practice Address - Phone:702-613-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV145600645OtherLEGACY'S NPI