Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD00046225 | WA |
Y | 207NP0225X | Pediatric Dermatologist | MD00046225 | WA |
NPI | 1013938620 |
---|---|
Provider Name | Dr. Vivian A Lombillo |
First Address | Olympia, WA 98506 |
Second Address | Olympia, WA 98506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 21/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03367104 | (05) | WA |