Provider Demographics
NPI:1164455374
Name:FORESTI-LORENTE, ROMILDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ROMILDA
Middle Name:
Last Name:FORESTI-LORENTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 VALENCIA ST STE 801
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4415
Mailing Address - Country:US
Mailing Address - Phone:415-401-1671
Mailing Address - Fax:
Practice Address - Street 1:1580 VALENCIA ST STE 801
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4415
Practice Address - Country:US
Practice Address - Phone:415-401-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29538Medicare UPIN
CA00A422480Medicare ID - Type Unspecified