Basic Information
| Provider Information | |||||||||
| NPI: | 1588659148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOMELI | ||||||||
| FirstName: | GABINO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 FOUNDERS PLZ | ||||||||
| Address2: | #300 C/O IPMS | ||||||||
| City: | EAST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061083212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602824137 | ||||||||
| FaxNumber: | 8602820170 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 FOUNDERS PLZ | ||||||||
| Address2: | #300 C/O IPMS | ||||||||
| City: | EAST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061083212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602824137 | ||||||||
| FaxNumber: | 8602820170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 03/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 027061 | CT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 001270610 | 05 | CO | MEDICAID |