Provider Demographics
NPI:1508801499
Name:ROMERO-URQUHART, GLENDA LEE (MD)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:LEE
Last Name:ROMERO-URQUHART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:LEE
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22691 BURLWOOD
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692
Mailing Address - Country:US
Mailing Address - Phone:714-835-6055
Mailing Address - Fax:714-835-3287
Practice Address - Street 1:1100 N. TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-835-6055
Practice Address - Fax:714-835-3287
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA720182085B0100X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
I01639Medicare UPIN