| Romeo L Isidro, Md, Inc | |
|
17075 Devonshire St Suite 204 Northridge CA 91325-1600 | |
| (818) 368-8929 | |
| Not Available |
| Full Name | Romeo L Isidro, Md, Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 17075 Devonshire St, Northridge, California |
| Authorized Official Name and Position | Romeo L Isidro (PRESIDENT) |
| Authorized Official Contact | 8183688929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Romeo L Isidro, Md, Inc 17075 Devonshire St Suite 204 Northridge CA 91325-1600 Ph: () - | Romeo L Isidro, Md, Inc 17075 Devonshire St Suite 204 Northridge CA 91325-1600 Ph: (818) 368-8929 |
| NPI Number | 1467484576 |
|---|---|
| Provider Enumeration Date | 07/07/2006 |
| Last Update Date | 05/26/2016 |
| Medicare PECOS PAC ID | 1052481215 |
|---|---|
| Medicare Enrollment ID | O20080530000753 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467484576 | NPI | - | NPPES |
| 00A418540 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Lydia K Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093729824 PECOS PAC ID: 7012914039 Enrollment ID: I20061103000197 |
| Provider Name | Romeo L Isidro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558393660 PECOS PAC ID: 2062582224 Enrollment ID: I20080530000740 |
| Provider Name | Gregorio De Grano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417392176 PECOS PAC ID: 6507005121 Enrollment ID: I20130611000838 |
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