Provider Demographics
NPI:1982307500
Name:LOMELI, BLANCA ESTELA
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:ESTELA
Last Name:LOMELI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:E
Other - Last Name:LOMELI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BLANCA ZARATE ,COTA
Mailing Address - Street 1:7128 TOKAY CIR
Mailing Address - Street 2:
Mailing Address - City:WINTON
Mailing Address - State:CA
Mailing Address - Zip Code:95388-9349
Mailing Address - Country:US
Mailing Address - Phone:559-285-6721
Mailing Address - Fax:
Practice Address - Street 1:510 W 26TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2804
Practice Address - Country:US
Practice Address - Phone:209-723-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA541224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant