Healthcare Provider Details

I. General information

NPI: 1477633626
Provider Name (Legal Business Name): JAMES HENRY ROUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE STE 750
ORANGE CA
92868-4312
US

IV. Provider business mailing address

1010 W LA VETA AVE STE 750
ORANGE CA
92868-4312
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-9401
  • Fax: 714-919-8804
Mailing address:
  • Phone: 714-639-9401
  • Fax: 714-919-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG62370
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG62370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: