Provider Demographics
NPI:1639241706
Name:ROMINES, PETER MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:ROMINES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W BONITA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2543
Mailing Address - Country:US
Mailing Address - Phone:916-743-4592
Mailing Address - Fax:209-474-0430
Practice Address - Street 1:5561 SEQUOIA CIR
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7936
Practice Address - Country:US
Practice Address - Phone:916-743-4592
Practice Address - Fax:209-474-0430
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0E2863213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E28630Medicaid
CAT11502Medicare UPIN
CA000E28630Medicaid