Provider Demographics
NPI:1134222102
Name:ROMEO, LISA A (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:ROMEO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1801 COLORADO AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2706
Mailing Address - Country:US
Mailing Address - Phone:209-216-3456
Mailing Address - Fax:209-216-3462
Practice Address - Street 1:1801 COLORADO AVE
Practice Address - Street 2:STE 120
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2706
Practice Address - Country:US
Practice Address - Phone:209-216-3456
Practice Address - Fax:209-216-3462
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-10-27
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Provider Licenses
StateLicense IDTaxonomies
CAG79809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG79809OtherLIC
CABR4331586OtherDEA
CABR4331586OtherDEA