Provider Demographics
NPI:1881894715
Name:ROMANENKO, DMITRIY (MD,)
Entity type:Individual
Prefix:DR
First Name:DMITRIY
Middle Name:
Last Name:ROMANENKO
Suffix:
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 1:7660 BEVERLY BLVD
Mailing Address - Street 2:#348
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2757
Mailing Address - Country:US
Mailing Address - Phone:323-240-1938
Mailing Address - Fax:
Practice Address - Street 1:5831 FIRESTONE BLVD STE E
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3718
Practice Address - Country:US
Practice Address - Phone:323-240-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94512207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology