Basic Information
| Provider Information | |||||||||
| NPI: | 1497942106 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROUMANIS JOHNSON | ||||||||
| FirstName: | PENNY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1762 WESTWOOD BLVD STE 230 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900245648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109438400 | ||||||||
| FaxNumber: | 3109239912 | ||||||||
| Practice Location | |||||||||
| Address1: | 47111 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | INDIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922016739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607758120 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2007 | ||||||||
| LastUpdateDate: | 06/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | A121083 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | A121083 | 01 | CA | MEDICAL BOARD OF CALIFORNIA | OTHER |