1659562379 NPI number — MR. BRADFORD DOUGLAS LOMBA SFIDC

Table of content: MR. BRADFORD DOUGLAS LOMBA SFIDC (NPI 1659562379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659562379 NPI number — MR. BRADFORD DOUGLAS LOMBA SFIDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOMBA
Provider First Name:
BRADFORD
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
SFIDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659562379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MEDICAL DEPARTMENT
Provider Second Line Business Mailing Address:
USS INGRAHAM FFG-61
Provider Business Mailing Address City Name:
FPO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96668 1515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-304-5692
Provider Business Mailing Address Fax Number:
425-304-5221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEDICAL DEPARTMENT
Provider Second Line Business Practice Location Address:
USS INGRAHAM FFG-61
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96668 1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-304-5692
Provider Business Practice Location Address Fax Number:
425-304-5221
Provider Enumeration Date:
08/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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