Healthcare Provider Details

I. General information

NPI: 1093755589
Provider Name (Legal Business Name): ROMANA HAIDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 SANTA MONICA BLVD 402
SANTA MONICA CA
90404-2045
US

IV. Provider business mailing address

9613 KIRKSIDE RD
LOS ANGELES CA
90035-4009
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-3385
  • Fax: 310-828-6635
Mailing address:
  • Phone: 310-838-8842
  • Fax: 310-838-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA78716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: