Provider Demographics
NPI:1619355757
Name:JUSTIN E ROME MD PC
Entity Type:Organization
Organization Name:JUSTIN E ROME MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-975-7091
Mailing Address - Street 1:256 S LA CIENEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3302
Mailing Address - Country:US
Mailing Address - Phone:310-975-7091
Mailing Address - Fax:
Practice Address - Street 1:256 S LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3302
Practice Address - Country:US
Practice Address - Phone:310-975-7091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty