Provider Demographics
NPI:1134330558
Name:ROMANO, JOHN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:ROMANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:73211 FRED WARING DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2871
Mailing Address - Country:US
Mailing Address - Phone:760-568-4939
Mailing Address - Fax:760-773-0001
Practice Address - Street 1:73211 FRED WARING DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2871
Practice Address - Country:US
Practice Address - Phone:760-568-4939
Practice Address - Fax:760-773-0001
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG 746892083X0100X
CAG74689208D00000X, 207QS0010X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF77403Medicare UPIN