Healthcare Provider Details

I. General information

NPI: 1679521033
Provider Name (Legal Business Name): JOSEPH PATRICK ROMEO SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 COLORADO AVENUE STE 160
TURLOCK CA
95382
US

IV. Provider business mailing address

1801 COLORADO AVENUE STE 160
TURLOCK CA
95382
US

V. Phone/Fax

Practice location:
  • Phone: 209-216-3300
  • Fax: 209-216-3301
Mailing address:
  • Phone: 209-216-3300
  • Fax: 209-216-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number00G806610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: