Provider Demographics
NPI:1568537314
Name:ROMERO, RAYMUNDO (MD)
Entity Type:Individual
Prefix:
First Name:RAYMUNDO
Middle Name:
Last Name:ROMERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WILSON TER
Mailing Address - Street 2:SUITE 340
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4071
Mailing Address - Country:US
Mailing Address - Phone:818-543-7574
Mailing Address - Fax:818-956-7609
Practice Address - Street 1:1505 WILSON TER
Practice Address - Street 2:SUITE 340
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4072
Practice Address - Country:US
Practice Address - Phone:818-543-7574
Practice Address - Fax:818-956-7609
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA75748207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology