NORTHWEST PEDIATRIC DERMATOLOGY, PLLC (NPI# 1588164925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588164925 |
| Entity Type | Organization |
| Organization Name | NORTHWEST PEDIATRIC DERMATOLOGY, PLLC |
| Other Organization Name | VIVIAN LOMBILLO, MD |
| Practice Address |
703 Lilly Rd Ne Ste 105 Olympia WA 98506-5191 |
| Mailing Address |
Po Box 2314 Olympia WA 98507-2314 |
| Practice Telephone | 3605396141 |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2018-02-12 |
| Authorized Official Name | DR. VIVIAN LOMBILLO (PHYSICIAN/OWNER) |
| Authorized Official Telephone | 3605396141 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | MD00046225 | WA | Allopathic & Osteopathic Physicians |
| Y | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
MD00046225 | WA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Vivian Lombillo, MD | Other Name - Individual/Organization |
| Street Address |
703 LILLY RD NE STE 105 |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98506-5191 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477185460 | Chloe Harper | Technician, Other | 3443 Lilly Rd Se, Ste B, Olympia, WA 98506 | 2020-02-07 |
| 1912543539 | Jessica Marie Radakovich | Licensed Practical Nurse | 3426 Mary Elder Rd, Olympia, WA 98506 | 2019-11-19 |
| 1669014973 | Arlene Josephine Adams | Registered Nurse | 413 Lily Rd Ne, Olympia, WA 98506 | 2019-10-09 |
| 1861999120 | Debra Delores Barker | Licensed Practical Nurse | 3710 South Bay Rd Ne, Olympia, WA 98506 | 2018-04-12 |
| 1801304431 | Michelle Warner | Nurse Practitioner | 205 Lilly Rd Ne Ste A1, Olympia, WA 98506 | 2018-01-17 |
| 1396258364 | Institute for Family Development | Community/Behavioral Health | 204 Quince St. Ne, Suite 200, Olympia, WA 98506 | 2017-11-13 |
| 1083137715 | Cameron Kunkel | Specialist/Technologist | 2512 20th Ave Ne, Olympia, WA 98506 | 2017-07-25 |
| 1184144768 | Trevor Shane Kwan | Family Medicine | 525 Lilly Road Ne, Olympia, WA 98506 | 2017-06-23 |
| 1073043212 | Michael H Harburg | Behavior Technician | 3857 Martin Way Ne, Olympia, WA 98506 | 2017-06-19 |
| 1780114371 | Priscilla Kangyang Jadu | Counselor | 3857 Martin Way E., Olympia, WA 98506 | 2017-06-15 |
| Find all providers in zip 98506 | ||||
| Taxonomy Code | 207NP0225X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Pediatric Dermatology |
| A pediatric dermatologist has, through additional special training, developed expertise in the treatment of specific skin disease categories with emphasis on those diseases which predominate in infants, children and adolescents. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: changed definition, added source] Additional Resources: American Board of Dermatology, 2007, http://www.abderm.org/ A subspecialty certificate was approved by ABMS in 2000. ACGME Accredited Residency Program Requirements: None. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326281353 | Deepti Gupta | Dermatology | 4800 Sand Point Way Ne, Seattle, WA 98105-3901 | 2009-04-07 |
| 1417083197 | Heather Alicia Brandling-bennett | Dermatology | 4800 Sand Point Way Ne, A-7916 - Dermatology, Seattle, WA 98105-3901 | 2007-02-26 |
| 1861507113 | Robert Sidbury | Dermatology | 4800 Sand Point Way Ne, Seattle Children's Hospital A7916, Seattle, WA 98105-3901 | 2006-08-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.