Healthcare Provider Details

I. General information

NPI: 1114019379
Provider Name (Legal Business Name): JOHN D ROMM MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 WILSHIRE BLVD STE #330
BEVERLY HILLS CA
90211-2007
US

IV. Provider business mailing address

8920 WILSHIRE BLVD STE #330
BEVERLY HILLS CA
90211-2007
US

V. Phone/Fax

Practice location:
  • Phone: 310-854-5638
  • Fax:
Mailing address:
  • Phone: 310-854-5638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC19015
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN D ROMM
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 310-654-5638