Healthcare Provider Details

I. General information

NPI: 1053855635
Provider Name (Legal Business Name): LILIANA ROMINE DH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9460 N NAME UNO SUITE 215
GILROY CA
95020-3537
US

IV. Provider business mailing address

2670 S WHITE RD SUITE 200
SAN JOSE CA
95148-2071
US

V. Phone/Fax

Practice location:
  • Phone: 408-797-2510
  • Fax:
Mailing address:
  • Phone: 408-729-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number18072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: