Healthcare Provider Details

I. General information

NPI: 1508801499
Provider Name (Legal Business Name): GLENDA LEE ROMERO-URQUHART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLENDA LEE ROMERO

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N. TUSTIN AVE
SANTA ANA CA
92705
US

IV. Provider business mailing address

22691 BURLWOOD
MISSION VIEJO CA
92692
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-6055
  • Fax: 714-835-3287
Mailing address:
  • Phone: 714-835-6055
  • Fax: 714-835-3287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA72018
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA72018
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberA72018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: