Provider Demographics
NPI:1134345226
Name:ROMINE, KATHLEEN K
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:K
Last Name:ROMINE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:KETRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4355 HAWK ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1318
Mailing Address - Country:US
Mailing Address - Phone:619-296-0789
Mailing Address - Fax:
Practice Address - Street 1:8210 FROST STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-966-5819
Practice Address - Fax:858-966-4930
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN257361163W00000X
CA12669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily