Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | G74689 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | G74689 | CA |
Y | 208D00000X | General Practice Physician | G74689 | CA |
NPI | 1134330558 |
---|---|
Provider Name | John Christopher Romano |
First Address | Palm Desert, CA 92260-2871 |
Second Address | Palm Desert, CA 92260-2871 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 06/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F77403 | (02) | CA |