Provider Demographics
NPI:1598053506
Name:ABAYA, ROMEO ARCEGA JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:ARCEGA
Last Name:ABAYA
Suffix:JR
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 1:2450 SISTER MARY COLUMBA DR
Mailing Address - Street 2:LASSEN MEDICAL GROUP INC.
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-4356
Mailing Address - Country:US
Mailing Address - Phone:530-527-0414
Mailing Address - Fax:530-528-4423
Practice Address - Street 1:20833 LONG BRANCH DR
Practice Address - Street 2:LASSEN MEDICAL GROUP INC
Practice Address - City:COTTONWOOD
Practice Address - State:CA
Practice Address - Zip Code:96022-8701
Practice Address - Country:US
Practice Address - Phone:530-347-3418
Practice Address - Fax:530-528-4423
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA199481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089250Medicaid
CA553957OtherRHC MEDICARE
CA553955OtherRHC MEDICARE
CARHM53955FFMedicaid
CARHM53955FFMedicaid
CAYYY20230YMedicare Oscar/Certification