Provider Demographics
NPI:1699226530
Name:HUMPHRIES, ROMNEY MCKENZIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROMNEY
Middle Name:MCKENZIE
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11633 SAN VICENTE BLVD
Mailing Address - Street 2:4TH FLOOR, REAR BUILDING
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6511
Mailing Address - Country:US
Mailing Address - Phone:310-794-3614
Mailing Address - Fax:310-794-2765
Practice Address - Street 1:11633 SAN VICENTE BLVD
Practice Address - Street 2:4TH FLOOR, REAR BUILDING
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6511
Practice Address - Country:US
Practice Address - Phone:310-794-3614
Practice Address - Fax:310-794-2765
Is Sole Proprietor?:No
Enumeration Date:2016-10-15
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTE958174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist