Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | C50503 | CA |
NPI | 1174673990 |
---|---|
Provider Name | Lucinda Romero |
First Address | Oakland, CA 94612-3466 |
Second Address | Santa Rosa, CA 95403-2149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 13/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C505030 | (05) | CA |
E04532 | (02) |