Provider Demographics
NPI:1386649713
Name:ROMAN, LYNDA D (MD)
Entity Type:Individual
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First Name:LYNDA
Middle Name:D
Last Name:ROMAN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1640 MARENGO ST
Mailing Address - Street 2:STE 505
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1038
Mailing Address - Country:US
Mailing Address - Phone:626-568-1622
Mailing Address - Fax:323-225-6284
Practice Address - Street 1:800 FAIRMOUNT AVE
Practice Address - Street 2:STE 220
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3154
Practice Address - Country:US
Practice Address - Phone:562-568-1622
Practice Address - Fax:562-568-1224
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2013-11-26
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Provider Licenses
StateLicense IDTaxonomies
CAG72001207VX0201X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G720010Medicaid
CAWG72001BMedicare PIN
CAB98160Medicare UPIN
CAWG72001CMedicare PIN