Provider Demographics
NPI:1871673004
Name:MEHRETAB ROMAN, YOHANNA ANGELES (MD)
Entity Type:Individual
Prefix:MRS
First Name:YOHANNA
Middle Name:ANGELES
Last Name:MEHRETAB ROMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:325 S LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-3693
Mailing Address - Country:US
Mailing Address - Phone:661-725-6266
Mailing Address - Fax:661-725-0407
Practice Address - Street 1:325 S LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3693
Practice Address - Country:US
Practice Address - Phone:661-725-6266
Practice Address - Fax:661-725-0407
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA92340208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics