Basic Information
| Provider Information | |||||||||
| NPI: | 1386649713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROMAN | ||||||||
| FirstName: | LYNDA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1640 MARENGO ST | ||||||||
| Address2: | STE 505 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900331038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265681622 | ||||||||
| FaxNumber: | 3232256284 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 FAIRMOUNT AVE | ||||||||
| Address2: | STE 220 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625681622 | ||||||||
| FaxNumber: | 5625681224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 11/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | G72001 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | 207VG0400X | G72001 | CA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00G720010 | 05 | CA | MEDICAID |