Healthcare Provider Details

I. General information

NPI: 1073057568
Provider Name (Legal Business Name): NATALIA ROMANOFF PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 W CLINTON AVE
FRESNO CA
93705-3805
US

IV. Provider business mailing address

1344 W CLINTON AVE
FRESNO CA
93705-3805
US

V. Phone/Fax

Practice location:
  • Phone: 559-741-4518
  • Fax:
Mailing address:
  • Phone: 559-741-4518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66557
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number029984
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: