Basic Information
| Provider Information | |||||||||
| NPI: | 1841543642 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOMELI | ||||||||
| FirstName: | MABEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11731 TELEGRAPH RD STE E | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906706821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629428256 | ||||||||
| FaxNumber: | 5629493587 | ||||||||
| Practice Location | |||||||||
| Address1: | 11731 TELEGRAPH RD STE E | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629428256 | ||||||||
| FaxNumber: | 5629493587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2012 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 07/31/2018 | ||||||||
| NPIReactivationDate: | 08/08/2018 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.