Healthcare Provider Details

I. General information

NPI: 1508201575
Provider Name (Legal Business Name): JASON VAN ROMPAEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HUNTINGTON DR
ARCADIA CA
91007-3402
US

IV. Provider business mailing address

223 N 1ST AVE STE 201
ARCADIA CA
91006-7027
US

V. Phone/Fax

Practice location:
  • Phone: 626-898-8004
  • Fax: 626-898-8235
Mailing address:
  • Phone: 626-821-1411
  • Fax: 626-821-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA132904
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA132904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: