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General NPI Number Information
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NPI Number | 1124761333
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Entity Type | Organization
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Legal Business Name | ROWENA LAGLEVA ROMERO
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Dates
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Enumeration Date | 04/15/2022
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 777 HICKEY BLVD
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City | PACIFICA
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State | CA
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Zip | 94044-1214
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Country | US
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Telephone | 650-359-7720
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Fax | 650-359-7785
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Provider Business Mailing Address
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Address Line | 1102 E 16TH AVE
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City | SAN MATEO
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State | CA
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Zip | 94402-2139
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Country | US
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Telephone | 650-787-8976
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | ROWENA LAGLEVA ROMERO
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Credential |
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Telephone | 650-787-8976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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