Provider Demographics
NPI:1386948073
Name:LOMELINO MEDICAL GROUP PC
Entity type:Organization
Organization Name:LOMELINO MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOMELINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-434-0025
Mailing Address - Street 1:1320 LAS TABLAS RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9711
Mailing Address - Country:US
Mailing Address - Phone:805-434-0025
Mailing Address - Fax:805-434-0029
Practice Address - Street 1:1320 LAS TABLAS RD
Practice Address - Street 2:SUITE F
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9711
Practice Address - Country:US
Practice Address - Phone:805-434-0025
Practice Address - Fax:805-434-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC3251367OtherSECRETARY OF STATE: DEPT OF CORPORATIONS NUMBER
CAC3251367OtherSECRETARY OF STATE: DEPT OF CORPORATIONS NUMBER