Provider Demographics
NPI:1730762469
Name:LOMBARDI, ROBERT (BS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LOMBARDI
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 RIDGE WATER DR
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-9735
Mailing Address - Country:US
Mailing Address - Phone:530-566-7543
Mailing Address - Fax:
Practice Address - Street 1:1968 RIDGE WATER DR
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479-9735
Practice Address - Country:US
Practice Address - Phone:530-566-7543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80281225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist