Healthcare Provider Details

I. General information

NPI: 1730193772
Provider Name (Legal Business Name): JOHN ANTHONY ROMANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 MOWRY AVE
FREMONT CA
94536-4113
US

IV. Provider business mailing address

686 MOWRY AVE
FREMONT CA
94536
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 NumberG047782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: