Provider Demographics
NPI:1386772770
Name:LOMONOSOFF, CATHERINE
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:LOMONOSOFF
Suffix:
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 1:194 EL SOLYO AVE
Mailing Address - Street 2:
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005-9505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1156 HIGH ST.
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA SANTA CRUZ STUDENT HEALTH
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95064
Practice Address - Country:US
Practice Address - Phone:831-459-2869
Practice Address - Fax:831-459-3546
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352176363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner