Provider Demographics
NPI:1700477155
Name:ROMEO C. AGBAYANI JR MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ROMEO C. AGBAYANI JR MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:MARIN ENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:OCHOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-461-9770
Mailing Address - Street 1:1000 S ELISEO DR STE 103
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2150
Mailing Address - Country:US
Mailing Address - Phone:415-461-9770
Mailing Address - Fax:415-366-8528
Practice Address - Street 1:1000 S ELISEO DR STE 103
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2150
Practice Address - Country:US
Practice Address - Phone:415-461-9770
Practice Address - Fax:415-366-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty