Provider Demographics
NPI:1629500210
Name:ROMANOV, SERGEI SERGEEVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGEI
Middle Name:SERGEEVICH
Last Name:ROMANOV
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 1:5932 CABRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3812
Mailing Address - Country:US
Mailing Address - Phone:310-775-1814
Mailing Address - Fax:
Practice Address - Street 1:4860 Y ST STE 3100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-5059
Practice Address - Fax:916-734-8490
Is Sole Proprietor?:No
Enumeration Date:2017-04-01
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1796802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program