Healthcare Provider Details

I. General information

NPI: 1568537314
Provider Name (Legal Business Name): RAYMUNDO ROMERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WILSON TER SUITE 340
GLENDALE CA
91206-4072
US

IV. Provider business mailing address

1505 WILSON TER SUITE 340
GLENDALE CA
91206-4071
US

V. Phone/Fax

Practice location:
  • Phone: 818-543-7574
  • Fax: 818-956-7609
Mailing address:
  • Phone: 818-543-7574
  • Fax: 818-956-7609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA75748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: