1114980034 NPI number — ADVANCED LAPAROSCOPIC SURGERY ASSOCIATES MEDICAL GROUP INC

Table of content: KATHERINE MARIE ROMO PMHNP (NPI 1942942396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114980034 NPI number — ADVANCED LAPAROSCOPIC SURGERY ASSOCIATES MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED LAPAROSCOPIC SURGERY ASSOCIATES MEDICAL GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1114980034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 28947
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93729-8947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-228-5448
Provider Business Mailing Address Fax Number:
559-224-3920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 E RIVER PARK CIR
Provider Second Line Business Practice Location Address:
#460
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-1571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-261-4500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HIGA
Authorized Official First Name:
KELVIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
559-228-5448

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  G53771 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0098660 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ26512Z . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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