Healthcare Provider Details

I. General information

NPI: 1124463575
Provider Name (Legal Business Name): JIA WANG ROMITO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JIA WANG

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD
DALLAS TX
75390-7201
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-3433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberR3418
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR3418
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: