Provider Demographics
NPI:1841628948
Name:DR ROME WALTER AN OSTEOPATHIC CORPORATION
Entity type:Organization
Organization Name:DR ROME WALTER AN OSTEOPATHIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROME
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-696-2215
Mailing Address - Street 1:38860 SKY CANYON DR
Mailing Address - Street 2:BUILDING #A
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2540
Mailing Address - Country:US
Mailing Address - Phone:951-696-2215
Mailing Address - Fax:951-696-2286
Practice Address - Street 1:38860 SKY CANYON DR
Practice Address - Street 2:BUILDING #A
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2540
Practice Address - Country:US
Practice Address - Phone:951-696-2215
Practice Address - Fax:951-696-2286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty