Provider Demographics
NPI:1558540146
Name:ROMUALDO-FERNANDEZ, JEAN DELGADO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:DELGADO
Last Name:ROMUALDO-FERNANDEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:JEAN
Other - Middle Name:DELGADO
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3400 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4511
Mailing Address - Country:US
Mailing Address - Phone:562-529-3298
Mailing Address - Fax:562-529-6282
Practice Address - Street 1:3400 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90805-4511
Practice Address - Country:US
Practice Address - Phone:562-529-3298
Practice Address - Fax:562-529-6282
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH44624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist