Provider Demographics
NPI:1083957393
Name:LINGAD, ROMAR BAGANG (FNP, MSN, RN)
Entity Type:Individual
Prefix:PROF
First Name:ROMAR
Middle Name:BAGANG
Last Name:LINGAD
Suffix:
Gender:M
Credentials:FNP, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 BAGLEY AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2836
Mailing Address - Country:US
Mailing Address - Phone:310-733-8097
Mailing Address - Fax:
Practice Address - Street 1:5015 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-3116
Practice Address - Country:US
Practice Address - Phone:232-216-2068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22964363L00000X, 364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner