Provider Demographics
NPI:1962862052
Name:DIMLA, ROMERSON (MD)
Entity Type:Individual
Prefix:
First Name:ROMERSON
Middle Name:
Last Name:DIMLA
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 1:2401 S HACIENDA BLVD
Mailing Address - Street 2:APT 342
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4762
Mailing Address - Country:US
Mailing Address - Phone:949-689-8572
Mailing Address - Fax:
Practice Address - Street 1:2401 S HACIENDA BLVD
Practice Address - Street 2:APT 342
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-4762
Practice Address - Country:US
Practice Address - Phone:949-689-8572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141073207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology