Provider Demographics
NPI:1205909603
Name:AGBAYANI, ROMEO C JR (MD)
Entity type:Individual
Prefix:
First Name:ROMEO
Middle Name:C
Last Name:AGBAYANI
Suffix:JR
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 1:1000 S ELISEO DR
Mailing Address - Street 2:# 103
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2133
Mailing Address - Country:US
Mailing Address - Phone:415-461-9770
Mailing Address - Fax:415-461-6744
Practice Address - Street 1:1000 S ELISEO DR
Practice Address - Street 2:# 103
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2133
Practice Address - Country:US
Practice Address - Phone:415-461-9770
Practice Address - Fax:415-461-6744
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81045207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA040016483OtherMCR RAILROAD
CA00G810450Medicaid
CA00G810450Medicaid
CA00G810450Medicare ID - Type Unspecified