# LOMBA MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336719699
- **Authorized official:** FERNANDO LUIS LOMBA (OWNER)
- **Authorized official phone:** (941) 766-4120

## Contact information

- **Practice address:** 410 S 11TH ST, LAKE WALES, FL 33853-4203
- **Practice address phone:** (863) 676-1433
- **Mailing address:** PO BOX 742291, ATLANTA, GA 30374-2291

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | NULL | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/29/2021
- **Last updated:** 06/29/2021