Healthcare Provider Details

I. General information

NPI: 1447523014
Provider Name (Legal Business Name): JOHN ROMANO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39380 CIVIC CENTER DR STE B
FREMONT CA
94538-6719
US

IV. Provider business mailing address

39380 CIVIC CENTER DR STE B
FREMONT CA
94538-6719
US

V. Phone/Fax

Practice location:
  • Phone: 510-794-5010
  • Fax: 510-794-5143
Mailing address:
  • Phone: 510-794-5010
  • Fax: 510-794-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG47782
License Number StateCA

VIII. Authorized Official

Name: JOHN A ROMANO
Title or Position: PRESIDENT
Credential: MD
Phone: 510-794-5010